Active NPI
Jennifer Chisholm, LICSW, MLADC
- Clinical Social Worker
- Manchester, NH
National Provider Identifier
1134464019
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Social Worker
- License
- 1788
- Practice address
- 464 Chestnut St
Manchester, NH 03101-1804 - Phone
- (603) 518-4325
- Fax
- (603) 668-6260
- NPI assigned
- Dec 4, 2012
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Addiction (Substance Use Disorder) Counselor | 101YA0400X | 0887 | NH | |
| Clinical Social Worker | 1041C0700X | 1788 | NH | Primary |
Addresses
Primary practice location
464 Chestnut St
Manchester, NH 03101-1804
Mailing address
464 Chestnut St
Manchester, NH 03101-1804
Phone (603) 518-4325
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 1788 | NH | MD | Physician Assistant |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1354579200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1404345600000",
"number": "1134464019",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "464 CHESTNUT ST",
"city": "MANCHESTER",
"state": "NH",
"postal_code": "031011804",
"telephone_number": "603-518-4325",
"fax_number": "603-668-6260"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "464 CHESTNUT ST",
"city": "MANCHESTER",
"state": "NH",
"postal_code": "031011804",
"telephone_number": "603-518-4325",
"fax_number": "603-668-6260"
}
],
"practiceLocations": [],
"basic": {
"last_name": "CHISHOLM",
"first_name": "JENNIFER",
"credential": "LICSW, MLADC",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2012-12-04",
"last_updated": "2014-07-03",
"status": "A"
},
"taxonomies": [
{
"code": "101YA0400X",
"taxonomy_group": "",
"desc": "Counselor, Addiction (Substance Use Disorder)",
"state": "NH",
"license": "0887",
"primary": false
},
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "NH",
"license": "1788",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Manchester, NH
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 3, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.