Provider Demographics
NPI:1902255649
Name:ALLEN, JAIMIE Z (MA, LCMHC, R-DMT)
Entity Type:Individual
Prefix:MRS
First Name:JAIMIE
Middle Name:Z
Last Name:ALLEN
Suffix:
Gender:F
Credentials:MA, LCMHC, R-DMT
Other - Prefix:MS
Other - First Name:JAIMIE
Other - Middle Name:LYNNE
Other - Last Name:ZABLOCKI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:441 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:KEENE
Mailing Address - State:NH
Mailing Address - Zip Code:03431-4181
Mailing Address - Country:US
Mailing Address - Phone:603-903-1414
Mailing Address - Fax:603-352-0685
Practice Address - Street 1:441 MAIN ST
Practice Address - Street 2:
Practice Address - City:KEENE
Practice Address - State:NH
Practice Address - Zip Code:03431-4181
Practice Address - Country:US
Practice Address - Phone:603-903-1414
Practice Address - Fax:603-352-0685
Is Sole Proprietor?:No
Enumeration Date:2016-06-03
Last Update Date:2016-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH1194101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health