Provider Demographics
NPI:1457656027
Name:EMMONS, STEPHANIE JALBERT (MSW, LICSW)
Entity Type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:JALBERT
Last Name:EMMONS
Suffix:
Gender:F
Credentials:MSW, LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:464 CHESTNUT ST
Mailing Address - Street 2:
Mailing Address - City:MANCHESTER
Mailing Address - State:NH
Mailing Address - Zip Code:03101-1804
Mailing Address - Country:US
Mailing Address - Phone:603-518-4000
Mailing Address - Fax:603-668-6260
Practice Address - Street 1:464 CHESTNUT ST
Practice Address - Street 2:
Practice Address - City:MANCHESTER
Practice Address - State:NH
Practice Address - Zip Code:03101-1804
Practice Address - Country:US
Practice Address - Phone:603-518-4000
Practice Address - Fax:603-668-6260
Is Sole Proprietor?:No
Enumeration Date:2011-01-12
Last Update Date:2011-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH02-02221641041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical