Provider Demographics
NPI:1497180434
Name:DELEAULT, JENESSA (PSYD)
Entity type:Individual
Prefix:DR
First Name:JENESSA
Middle Name:
Last Name:DELEAULT
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 412
Mailing Address - Street 2:
Mailing Address - City:CHESTER
Mailing Address - State:NH
Mailing Address - Zip Code:03036-0412
Mailing Address - Country:US
Mailing Address - Phone:603-600-7101
Mailing Address - Fax:603-600-7102
Practice Address - Street 1:1 NEW HAMPSHIRE AVE STE 125
Practice Address - Street 2:
Practice Address - City:PORTSMOUTH
Practice Address - State:NH
Practice Address - Zip Code:03801-2907
Practice Address - Country:US
Practice Address - Phone:603-600-7101
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-09-10
Last Update Date:2020-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH1358103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical