Basic Information
| Provider Information | |||||||||
| NPI: | 1770789133 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | UNIVERSITY ASSOCIATES, PC | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | UNIVERSITY ASSOCIATES IN PSYCHOLOGY, PC | ||||||||
| OtherOrganizationType: | 5 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 222 WEST ST | ||||||||
| Address2: | SUITE 29 | ||||||||
| City: | KEENE | ||||||||
| State: | NH | ||||||||
| PostalCode: | 034312455 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6033571180 | ||||||||
| FaxNumber: | 6033571185 | ||||||||
| Practice Location | |||||||||
| Address1: | 222 WEST ST | ||||||||
| Address2: | SUITE 29 | ||||||||
| City: | KEENE | ||||||||
| State: | NH | ||||||||
| PostalCode: | 034312455 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6033571180 | ||||||||
| FaxNumber: | 6033571185 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/22/2007 | ||||||||
| LastUpdateDate: | 09/25/2007 | ||||||||
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| AuthorizedOfficialLastName: | HARRIS | ||||||||
| AuthorizedOfficialFirstName: | JENNIFER | ||||||||
| AuthorizedOfficialMiddleName: | D | ||||||||
| AuthorizedOfficialTitleorPosition: | OFFICE MANAGER | ||||||||
| AuthorizedOfficialTelephone: | 6033571180 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 103T00000X | Y | 193200000X MULTI-SPECIALTY GROUP | Behavioral Health & Social Service Providers | Psychologist |
No ID Information.