Provider Demographics
NPI:1063951887
Name:HERLIHY, JESSICA LYNN (MS)
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:LYNN
Last Name:HERLIHY
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1111
Mailing Address - Street 2:
Mailing Address - City:MANCHESTER
Mailing Address - State:NH
Mailing Address - Zip Code:03105-1111
Mailing Address - Country:US
Mailing Address - Phone:603-261-5058
Mailing Address - Fax:603-244-1066
Practice Address - Street 1:309 PINE ST
Practice Address - Street 2:
Practice Address - City:MANCHESTER
Practice Address - State:NH
Practice Address - Zip Code:03103-5225
Practice Address - Country:US
Practice Address - Phone:603-261-5058
Practice Address - Fax:603-644-1066
Is Sole Proprietor?:No
Enumeration Date:2017-02-13
Last Update Date:2017-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health