Provider Demographics
NPI:1790875821
Name:COBB, JOANN (LICSW)
Entity Type:Individual
Prefix:
First Name:JOANN
Middle Name:
Last Name:COBB
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 1:99 HANOVER STREET
Mailing Address - Street 2:
Mailing Address - City:MANCHESTER
Mailing Address - State:NH
Mailing Address - Zip Code:03103
Mailing Address - Country:US
Mailing Address - Phone:603-668-1920
Mailing Address - Fax:603-668-6260
Practice Address - Street 1:99 HANOVER ST
Practice Address - Street 2:
Practice Address - City:MANCHESTER
Practice Address - State:NH
Practice Address - Zip Code:03101-2203
Practice Address - Country:US
Practice Address - Phone:603-668-1920
Practice Address - Fax:603-668-6260
Is Sole Proprietor?:No
Enumeration Date:2006-10-12
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH6311041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH80004065Medicaid
NHCO RE5619Medicare ID - Type UnspecifiedMEDICARE PROVIDER #