Healthcare Provider Details

I. General information

NPI: 1578815585
Provider Name (Legal Business Name): JEANETTE DUSTIN LMFT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/15/2012
Last Update Date: 08/02/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

25 OLD DOVER RD
ROCHESTER NH
03867-3464
US

IV. Provider business mailing address

404 CENTER RD
LEBANON ME
04027-3335
US

V. Phone/Fax

Practice location:
  • Phone: 603-516-9300
  • Fax:
Mailing address:
  • Phone: 207-206-4460
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: