Individual
MS. AMY MARIE JERSILD
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LCSW
Contact information
Practice address
1315 WALNUT ST STE 1004, PHILADELPHIA, PA 19107-4721
(215) 590-4766
(215) 590-4766
Mailing address
1720 DELANCEY ST, PHILADELPHIA, PA 19103-6715
(267) 303-5424
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
CW01498
CLINICAL SOCIAL WORK LICENSE
PA
Enumeration date
06/07/2017
Last updated
06/07/2017
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