Provider Demographics
NPI:1871879049
Name:MEMOLI, JESSICA LYNN (LCSW)
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:LYNN
Last Name:MEMOLI
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:455 SACKETT ST
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11231-5017
Mailing Address - Country:US
Mailing Address - Phone:516-316-1299
Mailing Address - Fax:
Practice Address - Street 1:286 5TH AVE # 7F
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10001-4512
Practice Address - Country:US
Practice Address - Phone:516-316-1299
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-11-01
Last Update Date:2021-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0831841041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical