Provider Demographics
NPI:1326752429
Name:JERGENSEN, ANDREA L (LICSW)
Entity Type:Individual
Prefix:
First Name:ANDREA
Middle Name:L
Last Name:JERGENSEN
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:841 CENTRAL ST STE 101
Mailing Address - Street 2:
Mailing Address - City:FRANKLIN
Mailing Address - State:NH
Mailing Address - Zip Code:03235-2053
Mailing Address - Country:US
Mailing Address - Phone:603-934-1464
Mailing Address - Fax:
Practice Address - Street 1:841 CENTRAL ST STE 101
Practice Address - Street 2:
Practice Address - City:FRANKLIN
Practice Address - State:NH
Practice Address - Zip Code:03235-2053
Practice Address - Country:US
Practice Address - Phone:603-934-1464
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-01-12
Last Update Date:2023-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH28861041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical