1871787960 NPI number — MS. JEANETTE 'GI' INDOCCIO LCMHC

Table of content: MS. JEANETTE 'GI' INDOCCIO LCMHC (NPI 1871787960)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1871787960 NPI number — MS. JEANETTE 'GI' INDOCCIO LCMHC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
INDOCCIO
Provider First Name:
JEANETTE
Provider Middle Name:
'GI'
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
LCMHC
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
WHITE
Provider Other First Name:
JEANETTE
Provider Other Middle Name:
Provider Other Name Prefix Text:
MRS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1871787960
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/31/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
330 BORTHWICK AVE
Provider Second Line Business Mailing Address:
SUITE # 111
Provider Business Mailing Address City Name:
PORTSMOUTH
Provider Business Mailing Address State Name:
NH
Provider Business Mailing Address Postal Code:
03801-4174
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
603-860-8645
Provider Business Mailing Address Fax Number:
603-343-2172

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
330 BORTHWICK AVE
Provider Second Line Business Practice Location Address:
SUITE # 111
Provider Business Practice Location Address City Name:
PORTSMOUTH
Provider Business Practice Location Address State Name:
NH
Provider Business Practice Location Address Postal Code:
03801-4174
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
603-860-8645
Provider Business Practice Location Address Fax Number:
603-343-2172
Provider Enumeration Date:
08/31/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 101YM0800X , with the licence number:  681 , registered in the state of NH ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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