Provider Demographics
NPI:1093002669
Name:PABLO, JEANNINE (LP, LCMHC, MLADC)
Entity Type:Individual
Prefix:DR
First Name:JEANNINE
Middle Name:
Last Name:PABLO
Suffix:
Gender:F
Credentials:LP, LCMHC, MLADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:713 CHESTNUT ST
Mailing Address - Street 2:
Mailing Address - City:MANCHESTER
Mailing Address - State:NH
Mailing Address - Zip Code:03104-3002
Mailing Address - Country:US
Mailing Address - Phone:603-668-9900
Mailing Address - Fax:603-668-9922
Practice Address - Street 1:713 CHESTNUT ST
Practice Address - Street 2:
Practice Address - City:MANCHESTER
Practice Address - State:NH
Practice Address - Zip Code:03104-3002
Practice Address - Country:US
Practice Address - Phone:603-668-9900
Practice Address - Fax:603-668-9922
Is Sole Proprietor?:Yes
Enumeration Date:2011-07-05
Last Update Date:2020-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH0694101YA0400X
NH904101YM0800X
NH00011103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health