Healthcare Provider Details

I. General information

NPI: 1730162843
Provider Name (Legal Business Name): WILLIAM J. JAMIESON PH.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/22/2005
Last Update Date: 07/02/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

61 NORTH ST
MANCHESTER NH
03104-3029
US

IV. Provider business mailing address

61 NORTH ST
MANCHESTER NH
03104-3029
US

V. Phone/Fax

Practice location:
  • Phone: 603-669-4130
  • Fax: 603-206-5438
Mailing address:
  • Phone: 603-669-4130
  • Fax: 603-669-4130

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103G00000X
TaxonomyClinical Neuropsychologist
License Number256
License Number StateNH
# 2
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number256
License Number StateNH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: