1720324171 NPI number — MS. SUSAN MARIE CONBOY LADC, LCS

Table of content: MS. SUSAN MARIE CONBOY LADC, LCS (NPI 1720324171)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1720324171 NPI number — MS. SUSAN MARIE CONBOY LADC, LCS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CONBOY
Provider First Name:
SUSAN
Provider Middle Name:
MARIE
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
LADC, LCS
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:
1720324171
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/12/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
250 PLEASANT ST
Provider Second Line Business Mailing Address:
SUITE 5400
Provider Business Mailing Address City Name:
CONCORD
Provider Business Mailing Address State Name:
NH
Provider Business Mailing Address Postal Code:
03301-7539
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
603-227-7000
Provider Business Mailing Address Fax Number:
603-227-7169

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
250 PLEASANT ST
Provider Second Line Business Practice Location Address:
SUITE 5400
Provider Business Practice Location Address City Name:
CONCORD
Provider Business Practice Location Address State Name:
NH
Provider Business Practice Location Address Postal Code:
03301-7539
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
603-227-7000
Provider Business Practice Location Address Fax Number:
603-227-7169
Provider Enumeration Date:
12/12/2012

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: 101YA0400X , with the licence number:  0565 , 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)





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