1780051359 NPI number — KATALYST PSYCHOLOGICAL FAMILY CENTER

Table of content: MR. LEONARD N. CAMP III PHARMACIST (NPI 1912119009)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1780051359 NPI number — KATALYST PSYCHOLOGICAL FAMILY CENTER

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
KATALYST PSYCHOLOGICAL FAMILY CENTER
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:
1780051359
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/30/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
17 OLDE LANTERN RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BEDFORD
Provider Business Mailing Address State Name:
NH
Provider Business Mailing Address Postal Code:
03110-4815
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
65 MIDDLE ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MANCHESTER
Provider Business Practice Location Address State Name:
NH
Provider Business Practice Location Address Postal Code:
03101-1905
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
603-213-0700
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
08/30/2015

Additional Information

Authorized Official

Authorized Official Last Name:
TOLSTIKOVA
Authorized Official First Name:
KATERINA
Authorized Official Middle Name:
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
603-213-0700

Provider Taxonomy Codes

  • Taxonomy code: 103T00000X , with the licence number:  1284 , 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)





Copyright © 2007-2025 www.npivalidator.com