Provider Demographics
NPI:1578815585
Name:DUSTIN, JEANETTE (LMFT)
Entity Type:Individual
Prefix:
First Name:JEANETTE
Middle Name:
Last Name:DUSTIN
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:404 CENTER RD
Mailing Address - Street 2:
Mailing Address - City:LEBANON
Mailing Address - State:ME
Mailing Address - Zip Code:04027-3335
Mailing Address - Country:US
Mailing Address - Phone:207-206-4460
Mailing Address - Fax:
Practice Address - Street 1:25 OLD DOVER RD
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NH
Practice Address - Zip Code:03867-3464
Practice Address - Country:US
Practice Address - Phone:603-516-9300
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-15
Last Update Date:2016-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist