Provider Demographics
NPI:1225216625
Name:MAIN STREET MENTAL HEALTH, PLLC
Entity Type:Organization
Organization Name:MAIN STREET MENTAL HEALTH, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:JOAN
Authorized Official - Middle Name:
Authorized Official - Last Name:ST JEAN
Authorized Official - Suffix:
Authorized Official - Credentials:APRN
Authorized Official - Phone:603-738-2445
Mailing Address - Street 1:PO BOX 535
Mailing Address - Street 2:
Mailing Address - City:MEREDITH
Mailing Address - State:NH
Mailing Address - Zip Code:03253-0535
Mailing Address - Country:US
Mailing Address - Phone:603-738-2445
Mailing Address - Fax:603-279-7042
Practice Address - Street 1:11 CANAL ST
Practice Address - Street 2:
Practice Address - City:MEREDITH
Practice Address - State:NH
Practice Address - Zip Code:03253-5902
Practice Address - Country:US
Practice Address - Phone:603-738-2445
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-07
Last Update Date:2022-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
261QM0850X
NH026459-23-08363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty
No261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH50Y011206NH01OtherANTHEM
2152562OtherCIGNA
NH3072631Medicaid
2152562OtherCIGNA