MEDICARE: JESSE WHITE

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103TC1900X	Counseling Psychologist

General Provider Information

NPI Number	:	1003930678
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JESSE WHITE

Provider Business Mailing Address
First Line	:	18 BAILEY AVE
Second Line	:
City	:	CLAREMONT
State	:	NH
Zip	:	03743-2704
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	9 HANOVER ST
Second Line	:	SUITE 2
City	:	LEBANON
State	:	NH
Zip	:	03766-1312
Country	:	US
Telephone Number	:	603-448-0126
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/19/2007
Last Update Date	:	07/08/2007

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Directions to “ JESSE WHITE ” Practice Location

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