Provider Demographics
NPI:1285721951
Name:JARZOMBEK, MICHAEL JOHN (MA)
Entity type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:JOHN
Last Name:JARZOMBEK
Suffix:
Gender:M
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:282 QUAKER ST
Mailing Address - Street 2:
Mailing Address - City:WEARE
Mailing Address - State:NH
Mailing Address - Zip Code:03281-4514
Mailing Address - Country:US
Mailing Address - Phone:603-529-1446
Mailing Address - Fax:
Practice Address - Street 1:30 CANTON ST
Practice Address - Street 2:SUITE 13
Practice Address - City:MANCHESTER
Practice Address - State:NH
Practice Address - Zip Code:03103-3524
Practice Address - Country:US
Practice Address - Phone:603-625-1670
Practice Address - Fax:603-625-0335
Is Sole Proprietor?:No
Enumeration Date:2006-10-06
Last Update Date:2014-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH601101YM0800X
NH1282103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health