Provider Demographics
NPI:1902526478
Name:BURDWOOD, JESSE WILLIAM
Entity Type:Individual
Prefix:MR
First Name:JESSE
Middle Name:WILLIAM
Last Name:BURDWOOD
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 CEDARBROOK DR
Mailing Address - Street 2:
Mailing Address - City:DOVER
Mailing Address - State:NH
Mailing Address - Zip Code:03820-2907
Mailing Address - Country:US
Mailing Address - Phone:603-767-7978
Mailing Address - Fax:
Practice Address - Street 1:103 STILES RD
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:NH
Practice Address - Zip Code:03079-4847
Practice Address - Country:US
Practice Address - Phone:603-434-1577
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-09-02
Last Update Date:2022-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH26371041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty