Provider Demographics
NPI:1275600413
Name:NOGALES, JEANETTE LYNN (MED, CAGS, LCMHC)
Entity Type:Individual
Prefix:MISS
First Name:JEANETTE
Middle Name:LYNN
Last Name:NOGALES
Suffix:
Gender:F
Credentials:MED, CAGS, LCMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 272
Mailing Address - Street 2:
Mailing Address - City:CAMPTON
Mailing Address - State:NH
Mailing Address - Zip Code:03223-0272
Mailing Address - Country:US
Mailing Address - Phone:603-568-8839
Mailing Address - Fax:
Practice Address - Street 1:85 MAIN ST
Practice Address - Street 2:SUITE 1
Practice Address - City:PLYMOUTH
Practice Address - State:NH
Practice Address - Zip Code:03264-1500
Practice Address - Country:US
Practice Address - Phone:603-568-8839
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-30
Last Update Date:2012-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH911101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH7706646Y0NH01OtherANTHEM