1003924747 NPI number — DEBRA GILLIGAN LCMHC

Table of content: DEBRA GILLIGAN LCMHC (NPI 1003924747)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1003924747 NPI number — DEBRA GILLIGAN LCMHC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
GILLIGAN
Provider First Name:
DEBRA
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
LCMHC
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1003924747
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/09/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 163
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
NEW BOSTON
Provider Business Mailing Address State Name:
NH
Provider Business Mailing Address Postal Code:
03070-0163
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
603-487-2665
Provider Business Mailing Address Fax Number:
603-964-7152

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
222 COURT ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PORTSMOUTH
Provider Business Practice Location Address State Name:
NH
Provider Business Practice Location Address Postal Code:
03801-4416
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
603-487-2246
Provider Business Practice Location Address Fax Number:
603-964-7152
Provider Enumeration Date:
08/25/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 1041C0700X , with the licence number:  584 , registered in the state of NH ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 366745 . This is a "MHN" identifier , issued by the state of ( NH ) . This identifiers is of the category "OTHER".
  • Identifier: 30423713 , issued by the state of ( NH ) . This identifiers is of the category "MEDICAID".
  • Identifier: 14Y008615NH01 . This is a "ANTHEM BCBS NUMBER" identifier , issued by the state of ( NH ) . This identifiers is of the category "OTHER".
  • Identifier: 2187705 . This is a "CIGNA BEHAVIORAL HEALTH" identifier , issued by the state of ( NH ) . This identifiers is of the category "OTHER".
  • Identifier: 7369626 . This is a "AETNA" identifier , issued by the state of ( NH ) . This identifiers is of the category "OTHER".




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