Provider Demographics
NPI:1700934742
Name:ABIKOFF, JACQUELINE (LICSW, M LADC)
Entity Type:Individual
Prefix:
First Name:JACQUELINE
Middle Name:
Last Name:ABIKOFF
Suffix:
Gender:F
Credentials:LICSW, M LADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25 COUNTRY CLUB RD
Mailing Address - Street 2:SUITE 705
Mailing Address - City:GILFORD
Mailing Address - State:NH
Mailing Address - Zip Code:03249-6972
Mailing Address - Country:US
Mailing Address - Phone:603-524-8005
Mailing Address - Fax:603-524-7275
Practice Address - Street 1:25 COUNTRY CLUB RD
Practice Address - Street 2:SUITE 705
Practice Address - City:GILFORD
Practice Address - State:NH
Practice Address - Zip Code:03249-6972
Practice Address - Country:US
Practice Address - Phone:603-524-8005
Practice Address - Fax:603-524-7275
Is Sole Proprietor?:No
Enumeration Date:2007-01-08
Last Update Date:2012-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH109101YA0400X
NH1761041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH30007637Medicaid