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General NPI Number Information
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NPI Number | 1538466750
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Entity Type | Individual
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Provider Name | MR. JEREMY KENT ANDERSEN
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Gender | Male
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Dates
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Enumeration Date | 02/24/2011
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Last Update Date | 12/18/2018
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Provider Practice Location Address
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Address Line | 211 NORTH ST STE 1
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City | NORTHAMPTON
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State | MA
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Zip | 01060
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Country | US
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Telephone | 413-588-2453
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 206
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City | NORTHAMPTON
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State | MA
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Zip | 01061-0206
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Country | US
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Telephone | 413-588-2453
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 10703
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License Number State | MA
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