1174707871 NPI number — BRIGHT DAY PSYCHOLOGY PLLC

Table of content: (NPI 1174707871)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1174707871 NPI number — BRIGHT DAY PSYCHOLOGY PLLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
BRIGHT DAY PSYCHOLOGY PLLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

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:
1174707871
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/23/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
135 ROCK STRAIN DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LITTLETON
Provider Business Mailing Address State Name:
NH
Provider Business Mailing Address Postal Code:
03561-4515
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
603-444-1512
Provider Business Mailing Address Fax Number:
866-599-7012

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
262 COTTAGE ST
Provider Second Line Business Practice Location Address:
SUITE 250
Provider Business Practice Location Address City Name:
LITTLETON
Provider Business Practice Location Address State Name:
NH
Provider Business Practice Location Address Postal Code:
03561-4146
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
603-444-1512
Provider Business Practice Location Address Fax Number:
866-599-7012
Provider Enumeration Date:
12/18/2007

Additional Information

Authorized Official

Authorized Official Last Name:
WARNER
Authorized Official First Name:
DEBORAH
Authorized Official Middle Name:
J
Authorized Official Title or Position:
OWNER/CLINICAL PSYCHOLOGIST
Authorized Official Telephone Number:
603-444-1512

Provider Taxonomy Codes

  • Taxonomy code: 103TC0700X , with the licence number:  526 , 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: 0803381Y0NH01 . This is a "BLUE CROSS" identifier , issued by the state of ( NH ) . This identifiers is of the category "OTHER".
  • Identifier: 151149000 . This is a "MAGELLAN" identifier , issued by the state of ( VT ) . This identifiers is of the category "OTHER".
  • Identifier: 222684864 . This is a "TRICARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 12005 . This is a "SSI" identifier , issued by the state of ( NH ) . This identifiers is of the category "OTHER".
  • Identifier: 30426314 , issued by the state of ( NH ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1003571 , issued by the state of ( VT ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1059863 . This is a "CIGNA" identifier , issued by the state of ( NH ) . This identifiers is of the category "OTHER".




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