Provider Demographics
NPI:1396403077
Name:PUTNAM, JESSICA (MS, LCMHC)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:
Last Name:PUTNAM
Suffix:
Gender:F
Credentials:MS, 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 720
Mailing Address - Street 2:
Mailing Address - City:ALSTEAD
Mailing Address - State:NH
Mailing Address - Zip Code:03602-0720
Mailing Address - Country:US
Mailing Address - Phone:603-835-7111
Mailing Address - Fax:
Practice Address - Street 1:FMRSD CENTRAL OFFICE
Practice Address - Street 2:122 NH ROUTE 12A
Practice Address - City:LANGDON
Practice Address - State:NH
Practice Address - Zip Code:03602
Practice Address - Country:US
Practice Address - Phone:603-835-7111
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-11-30
Last Update Date:2021-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH2391101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health