Provider Demographics
NPI:1821875998
Name:JANUS, JESSICA DIANE (LCMHC)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:DIANE
Last Name:JANUS
Suffix:
Gender:F
Credentials:LCMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:232 BEAR HILL RD
Mailing Address - Street 2:
Mailing Address - City:CHICHESTER
Mailing Address - State:NH
Mailing Address - Zip Code:03258-6206
Mailing Address - Country:US
Mailing Address - Phone:978-866-7906
Mailing Address - Fax:
Practice Address - Street 1:149 HANOVER ST STE 200
Practice Address - Street 2:
Practice Address - City:MANCHESTER
Practice Address - State:NH
Practice Address - Zip Code:03101-2245
Practice Address - Country:US
Practice Address - Phone:603-696-4872
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-09-12
Last Update Date:2023-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH2632101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health