| Limited Liability Corporation | |
|
5 South Main Street Plymouth NH 03264 | |
| (603) 536-5223 | |
| (603) 536-5223 |
| Full Name | Limited Liability Corporation |
|---|---|
| Speciality | Psychologist - Clinical |
| Location | 5 South Main Street, Plymouth, New Hampshire |
| Authorized Official Name and Position | Elizabeth Lachapelle (PSYCHOLOGIST MANAGER) |
| Authorized Official Contact | 6035365223 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Limited Liability Corporation Po Box 42 Plymouth NH 03264 Ph: (603) 536-5223 | Limited Liability Corporation 5 South Main Street Plymouth NH 03264 Ph: (603) 536-5223 |
| NPI Number | 1912079443 |
|---|---|
| Provider Enumeration Date | 11/13/2006 |
| Last Update Date | 08/22/2020 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1912079443 | NPI | - | NPPES |
| 30421468 | Medicaid | NH |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 103TC0700X | Psychologist - Clinical | 891 (New Hampshire) | Primary |
| 103TC0700X | Psychologist - Clinical | 4999 (Massachusetts) | Secondary |
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