Basic Information
Provider Information | |||||||||
NPI: | 1447525688 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | CARRIGG | ||||||||
FirstName: | DANICA | ||||||||
MiddleName: | MARIE | ||||||||
NamePrefix: |   | ||||||||
NameSuffix: |   | ||||||||
Credential: | MS | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: | WAGNER | ||||||||
OtherFirstName: | DANICA | ||||||||
OtherMiddleName: | MARIE | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: | MS | ||||||||
OtherLastNameType: | 1 | ||||||||
Mailing Information | |||||||||
Address1: | 7 PROSPECT ST | ||||||||
Address2: |   | ||||||||
City: | NASHUA | ||||||||
State: | NH | ||||||||
PostalCode: | 03060 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 6038896147 | ||||||||
FaxNumber: | 6038822017 | ||||||||
Practice Location | |||||||||
Address1: | 440 AMHERST ST | ||||||||
Address2: |   | ||||||||
City: | NASHUA | ||||||||
State: | NH | ||||||||
PostalCode: | 03063 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 6038896147 | ||||||||
FaxNumber: | 6038822017 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 03/21/2012 | ||||||||
LastUpdateDate: | 02/18/2020 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | F | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | N | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: | 02/18/2020 |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YM0800X |   |   | Y |   | Behavioral Health & Social Service Providers | Counselor | Mental Health |
ID Information
ID | Type | State | Issuer | Description | 1303295 | 05 | MA |   | MEDICAID | 1307576 | 05 | MA |   | MEDICAID | M18463 | 01 | MA | BLUE CROSS/BLUE SHIELD | OTHER |