Provider Demographics
NPI:1427086115
Name:STERN, JESSICA N
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:N
Last Name:STERN
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 1:32 KEARSARGE AVE
Mailing Address - Street 2:
Mailing Address - City:CONTOOCOOK
Mailing Address - State:NH
Mailing Address - Zip Code:03229-3103
Mailing Address - Country:US
Mailing Address - Phone:603-746-5353
Mailing Address - Fax:603-746-5454
Practice Address - Street 1:32 KEARSARGE AVE
Practice Address - Street 2:
Practice Address - City:CONTOOCOOK
Practice Address - State:NH
Practice Address - Zip Code:03229-3103
Practice Address - Country:US
Practice Address - Phone:603-746-5353
Practice Address - Fax:603-746-5454
Is Sole Proprietor?:No
Enumeration Date:2006-06-29
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH937103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH2078498OtherPROVIDER ID
NH19792867OtherPROVIDER ID
NH30424257Medicaid
MA364796OtherPROVIDER ID
NH06Y001205NH02OtherPROVIDER ID
NH3297-01OtherPROVIDER ID