Healthcare Provider Details

I. General information

NPI: 1912055260
Provider Name (Legal Business Name): JOHN E. SARGENT M.S, LCMHC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/05/2007
Last Update Date: 07/12/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 MARKET ST SUITE 1G
PORTSMOUTH NH
03801-3458
US

IV. Provider business mailing address

129 WHIPPLE RD
KITTERY ME
03904-1316
US

V. Phone/Fax

Practice location:
  • Phone: 603-502-4246
  • Fax:
Mailing address:
  • Phone: 207-439-4531
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number501
License Number StateNH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: