Basic Information
| Provider Information | |||||||||
| NPI: | 1306320999 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | THE MENTAL HEALTH CTR FOR SOUTHERN NEW HAMPSHIRE | ||||||||
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| Mailing Information | |||||||||
| Address1: | 10 TSIENNETO RD | ||||||||
| Address2: | |||||||||
| City: | DERRY | ||||||||
| State: | NH | ||||||||
| PostalCode: | 030381505 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6034341577 | ||||||||
| FaxNumber: | 6034343101 | ||||||||
| Practice Location | |||||||||
| Address1: | 10 TSIENNETO RD | ||||||||
| Address2: | |||||||||
| City: | DERRY | ||||||||
| State: | NH | ||||||||
| PostalCode: | 030381505 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6034341577 | ||||||||
| FaxNumber: | 6034343101 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/19/2018 | ||||||||
| LastUpdateDate: | 09/19/2018 | ||||||||
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| AuthorizedOfficialLastName: | MASSERO | ||||||||
| AuthorizedOfficialFirstName: | JODY | ||||||||
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| AuthorizedOfficialTitleorPosition: | AR SUPERVISOR | ||||||||
| AuthorizedOfficialTelephone: | 6039650722 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 251S00000X | Y | Agencies | Community/Behavioral Health |
No ID Information.