Provider Demographics
NPI:1164836243
Name:SCONZO, JESSICA B
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:B
Last Name:SCONZO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:JESSICA
Other - Middle Name:B
Other - Last Name:SCONZO
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MSW
Mailing Address - Street 1:6060 PIEDMONT ROW DR S STE 511
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28287-3887
Mailing Address - Country:US
Mailing Address - Phone:848-667-6021
Mailing Address - Fax:
Practice Address - Street 1:6060 PIEDMONT ROW DR S STE 511
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28287-3887
Practice Address - Country:US
Practice Address - Phone:848-667-6021
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-06-17
Last Update Date:2025-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCC0111541041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical