1003997263 NPI number — MR. NATHAN ANDREW MANLOVE LICSW

Table of content: MR. NATHAN ANDREW MANLOVE LICSW (NPI 1003997263)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1003997263 NPI number — MR. NATHAN ANDREW MANLOVE LICSW

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MANLOVE
Provider First Name:
NATHAN
Provider Middle Name:
ANDREW
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
Provider Credential Text:
LICSW
Provider Gender Code:
M

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:
1003997263
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/07/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
MOUNTAIN WELLNESS ASSOCIATES
Provider Second Line Business Mailing Address:
163 WASHINGTON STREET
Provider Business Mailing Address City Name:
KEENE
Provider Business Mailing Address State Name:
NH
Provider Business Mailing Address Postal Code:
03431-3131
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
603-283-0195
Provider Business Mailing Address Fax Number:
603-283-0197

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
MOUNTAIN WELLNESS ASSOCIATES
Provider Second Line Business Practice Location Address:
163 WASHINGTON STREET
Provider Business Practice Location Address City Name:
KEENE
Provider Business Practice Location Address State Name:
NH
Provider Business Practice Location Address Postal Code:
03431-3131
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
603-283-0195
Provider Business Practice Location Address Fax Number:
603-283-0197
Provider Enumeration Date:
10/17/2006

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: 101Y00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 3078508 , issued by the state of ( NH ) . This identifiers is of the category "MEDICAID".
  • Identifier: 81263595 , issued by the state of ( NH ) . This identifiers is of the category "MEDICAID".




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