1205042421 NPI number — CHARLENE CURTIS, LLC LICSW

Table of content: (NPI 1205042421)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1205042421 NPI number — CHARLENE CURTIS, LLC LICSW

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CHARLENE CURTIS, LLC LICSW
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:
1205042421
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
188 ELM ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MILFORD
Provider Business Mailing Address State Name:
NH
Provider Business Mailing Address Postal Code:
03055-4761
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
603-673-5003
Provider Business Mailing Address Fax Number:
603-673-3002

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
188 ELM ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MILFORD
Provider Business Practice Location Address State Name:
NH
Provider Business Practice Location Address Postal Code:
03055-4761
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
603-673-5003
Provider Business Practice Location Address Fax Number:
603-673-3002
Provider Enumeration Date:
05/15/2007

Additional Information

Authorized Official

Authorized Official Last Name:
CURTIS
Authorized Official First Name:
CHARLENE
Authorized Official Middle Name:
MARIE
Authorized Official Title or Position:
LICSW
Authorized Official Telephone Number:
603-673-5003

Provider Taxonomy Codes

  • Taxonomy code: 1041C0700X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 11429999 . This is a "CAQH" identifier , issued by the state of ( NH ) . This identifiers is of the category "OTHER".
  • Identifier: 30424590 , issued by the state of ( NH ) . This identifiers is of the category "MEDICAID".




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