Provider Demographics
NPI:1912055260
Name:SARGENT, JOHN E (MS, LCMHC)
Entity Type:Individual
Prefix:MR
First Name:JOHN
Middle Name:E
Last Name:SARGENT
Suffix:
Gender:M
Credentials:MS, LCMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:129 WHIPPLE RD
Mailing Address - Street 2:
Mailing Address - City:KITTERY
Mailing Address - State:ME
Mailing Address - Zip Code:03904-1316
Mailing Address - Country:US
Mailing Address - Phone:207-439-4531
Mailing Address - Fax:
Practice Address - Street 1:500 MARKET ST
Practice Address - Street 2:SUITE 1G
Practice Address - City:PORTSMOUTH
Practice Address - State:NH
Practice Address - Zip Code:03801-3458
Practice Address - Country:US
Practice Address - Phone:603-502-4246
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-05
Last Update Date:2007-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH501101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH14Y008135NH01OtherBCBS ANTHEM