Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103TB0200X | Cognitive & Behavioral Psychologist | NH718 | NH |
NPI | 1194840249 |
---|---|
Provider Name | Constance Johannessen |
First Address | North Hampton, NH 03862-2464 |
Second Address | North Hampton, NH 03862-2464 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/03/2007 |
Last Update Date | 25/03/2010 |