Basic Information
| Provider Information | |||||||||
| NPI: | 1376502716 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BAGSHAW | ||||||||
| FirstName: | LINDA | ||||||||
| MiddleName: | J. | ||||||||
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| Credential: | LCMHC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 445 CYPRESS ST | ||||||||
| Address2: | SUITE 8 | ||||||||
| City: | MANCHESTER | ||||||||
| State: | NH | ||||||||
| PostalCode: | 031033600 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6036684079 | ||||||||
| FaxNumber: | 6036638605 | ||||||||
| Practice Location | |||||||||
| Address1: | 445 CYPRESS ST | ||||||||
| Address2: | SUITE 8 | ||||||||
| City: | MANCHESTER | ||||||||
| State: | NH | ||||||||
| PostalCode: | 031033600 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6036684079 | ||||||||
| FaxNumber: | 6036638605 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/23/2006 | ||||||||
| LastUpdateDate: | 02/22/2010 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YM0800X | 550 | NH | Y | Behavioral Health & Social Service Providers | Counselor | Mental Health |
ID Information
| ID | Type | State | Issuer | Description | 14Y008150NH01 | 01 | NH | ANTHEM ACES # | OTHER | 387278 | 01 | NH | MVP PIN | OTHER | 2218716 | 01 | NH | CIGNA NH PIN | OTHER | 30423320 | 05 | NH | MEDICAID |