Provider Demographics
NPI:1013128180
Name:PINKHAM, JESSICA M (LICSW)
Entity Type:Individual
Prefix:MS
First Name:JESSICA
Middle Name:M
Last Name:PINKHAM
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:JESSICA
Other - Middle Name:M
Other - Last Name:MINER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LICSW
Mailing Address - Street 1:323 GONIC RD STE 2A
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NH
Mailing Address - Zip Code:03839-5689
Mailing Address - Country:US
Mailing Address - Phone:603-332-8000
Mailing Address - Fax:603-601-4476
Practice Address - Street 1:323 GONIC RD STE 2A
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NH
Practice Address - Zip Code:03839-5689
Practice Address - Country:US
Practice Address - Phone:603-332-8000
Practice Address - Fax:603-601-4476
Is Sole Proprietor?:No
Enumeration Date:2007-05-24
Last Update Date:2022-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH14021041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH3101188Medicaid
NH3077091Medicaid
NH30931444Medicaid