Individual
JESSE R NORTHRIDGE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
LCSW
Contact information
Practice address
22 NORTHEAST DR, HERSHEY, PA 17033-2732
(717) 531-8338
(717) 531-6250
Mailing address
PO BOX 858, MC A410, HERSHEY, PA 17033-0858
(800) 243-1455
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
SW134804
PA
1041C0700X
Clinical Social Worker
Primary
CW021046
PA
Other
Enumeration date
12/18/2017
Last updated
02/07/2020
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