Provider Demographics
NPI:1730162843
Name:JAMIESON, WILLIAM J (PHD)
Entity type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:J
Last Name:JAMIESON
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:61 NORTH ST
Mailing Address - Street 2:
Mailing Address - City:MANCHESTER
Mailing Address - State:NH
Mailing Address - Zip Code:03104-3029
Mailing Address - Country:US
Mailing Address - Phone:603-669-4130
Mailing Address - Fax:603-669-4130
Practice Address - Street 1:61 NORTH ST
Practice Address - Street 2:
Practice Address - City:MANCHESTER
Practice Address - State:NH
Practice Address - Zip Code:03104-3029
Practice Address - Country:US
Practice Address - Phone:603-669-4130
Practice Address - Fax:603-206-5438
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-22
Last Update Date:2012-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH256103G00000X, 103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH0602234Y0NH02OtherANTHEM
NH30422687Medicaid
NH0602234Y0NH02OtherANTHEM