Provider Demographics
NPI:1144933680
Name:JENNIFER WHITEHEAD
Entity type:Organization
Organization Name:JENNIFER WHITEHEAD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:
Authorized Official - Last Name:WHITEHEAD
Authorized Official - Suffix:
Authorized Official - Credentials:LICSW, MLADC
Authorized Official - Phone:603-620-3662
Mailing Address - Street 1:196 SOUTH LINCOLN STREET
Mailing Address - Street 2:KEENE
Mailing Address - City:KEENE
Mailing Address - State:NH
Mailing Address - Zip Code:03431
Mailing Address - Country:US
Mailing Address - Phone:603-620-3662
Mailing Address - Fax:
Practice Address - Street 1:25 ROXBURY ST
Practice Address - Street 2:
Practice Address - City:KEENE
Practice Address - State:NH
Practice Address - Zip Code:03431-3257
Practice Address - Country:US
Practice Address - Phone:603-620-3662
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:JENNIFER WHITEHEAD
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2022-12-29
Last Update Date:2022-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH3121329Medicaid