Healthcare Provider Details

I. General information

NPI: 1760023311
Provider Name (Legal Business Name): JEMB, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/04/2019
Last Update Date: 10/04/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2 WASHINGTON ST STE 216
DOVER NH
03820-3893
US

IV. Provider business mailing address

2 WASHINGTON ST STE 216
DOVER NH
03820-3893
US

V. Phone/Fax

Practice location:
  • Phone: 603-200-3035
  • Fax:
Mailing address:
  • Phone: 603-200-3035
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name: JOHN ELDREDGE
Title or Position: MEMBER
Credential: LICSW, MLADC
Phone: 603-200-3035