Healthcare Provider Details

I. General information

NPI: 1457656027
Provider Name (Legal Business Name): STEPHANIE JALBERT EMMONS MSW, LICSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/12/2011
Last Update Date: 01/12/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

464 CHESTNUT ST
MANCHESTER NH
03101-1804
US

IV. Provider business mailing address

464 CHESTNUT ST
MANCHESTER NH
03101-1804
US

V. Phone/Fax

Practice location:
  • Phone: 603-518-4000
  • Fax: 603-668-6260
Mailing address:
  • Phone: 603-518-4000
  • Fax: 603-668-6260

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number02-0222164
License Number StateNH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: