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NPI Code Detail

MEDICARE: JILLIAN BEVERSTOCK MS

MEDICARE: JILLIAN BEVERSTOCK MS
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
1106H00000XMarriage & Family Therapist

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1831307016
Entity Type Code : Individual
Provider Name (Legal Business Name) : JILLIAN BEVERSTOCK MS
Provider Business Mailing Address
First Line : 113 CROSBY RD
Second Line :
City : DOVER
State : NH
Zip : 03820-4370
Country : US
Telephone Number : 603-749-4015
Fax Number :
Provider Business Practice Location Address
First Line : 25 OLD DOVER RD
Second Line :
City : ROCHESTER
State : NH
Zip : 03867-3464
Country : US
Telephone Number : 603-335-6470
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/19/2007
Last Update Date : 07/08/2007

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