Provider Demographics
NPI:1417773656
Name:VAN NESS, EMMA KATHERINE
Entity type:Individual
Prefix:
First Name:EMMA
Middle Name:KATHERINE
Last Name:VAN NESS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 WARREN ST
Mailing Address - Street 2:
Mailing Address - City:PLYMOUTH
Mailing Address - State:NH
Mailing Address - Zip Code:03264-1416
Mailing Address - Country:US
Mailing Address - Phone:603-481-1478
Mailing Address - Fax:
Practice Address - Street 1:1 WARREN ST
Practice Address - Street 2:
Practice Address - City:PLYMOUTH
Practice Address - State:NH
Practice Address - Zip Code:03264-1416
Practice Address - Country:US
Practice Address - Phone:603-481-1478
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-12-03
Last Update Date:2024-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH4819101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health