Provider Demographics
NPI:1114701695
Name:JEANSONNE, CHANDLER
Entity Type:Individual
Prefix:
First Name:CHANDLER
Middle Name:
Last Name:JEANSONNE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:124 AMERICAN LEGION DR
Mailing Address - Street 2:
Mailing Address - City:NORTH ADAMS
Mailing Address - State:MA
Mailing Address - Zip Code:01247-3942
Mailing Address - Country:US
Mailing Address - Phone:413-770-0980
Mailing Address - Fax:
Practice Address - Street 1:124 AMERICAN LEGION DR
Practice Address - Street 2:
Practice Address - City:NORTH ADAMS
Practice Address - State:MA
Practice Address - Zip Code:01247-3942
Practice Address - Country:US
Practice Address - Phone:413-770-0980
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-08-24
Last Update Date:2023-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor