Provider Demographics
NPI:1710023841
Name:JEPSON-HEBERT, JUDITH MICHELE (LICSW)
Entity Type:Individual
Prefix:MS
First Name:JUDITH
Middle Name:MICHELE
Last Name:JEPSON-HEBERT
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 1:130 BROOK ST
Mailing Address - Street 2:
Mailing Address - City:MANCHESTER
Mailing Address - State:NH
Mailing Address - Zip Code:03104-3620
Mailing Address - Country:US
Mailing Address - Phone:603-644-2683
Mailing Address - Fax:
Practice Address - Street 1:1193 HOOKSETT RD
Practice Address - Street 2:
Practice Address - City:HOOKSETT
Practice Address - State:NH
Practice Address - Zip Code:03106-1004
Practice Address - Country:US
Practice Address - Phone:603-644-2683
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-29
Last Update Date:2016-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH12251041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH30423641Medicaid