Healthcare Provider Details

I. General information

NPI: 1174656334
Provider Name (Legal Business Name): JENNIFER SUE PARKHURST LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/14/2007
Last Update Date: 09/18/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

32 OSGOOD ST THE PROFESSIONAL CENTER FOR CHILD DEVELOPMENT
ANDOVER MA
01810
US

IV. Provider business mailing address

38 LAWRENCE RD
DERRY NH
03038-4191
US

V. Phone/Fax

Practice location:
  • Phone: 978-475-3806
  • Fax: 978-475-6288
Mailing address:
  • Phone: 603-216-2603
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number116717
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: