Provider Demographics
NPI:1154284370
Name:NORTHERN LIGHTS PSYCHIATRY SERVICE LLP
Entity type:Organization
Organization Name:NORTHERN LIGHTS PSYCHIATRY SERVICE LLP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:APRN OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ANGELA
Authorized Official - Middle Name:LEIGH
Authorized Official - Last Name:PETERS
Authorized Official - Suffix:
Authorized Official - Credentials:APRN
Authorized Official - Phone:603-718-3939
Mailing Address - Street 1:15 CONSTITUTION DR OFC 113
Mailing Address - Street 2:
Mailing Address - City:BEDFORD
Mailing Address - State:NH
Mailing Address - Zip Code:03110-6042
Mailing Address - Country:US
Mailing Address - Phone:603-718-3939
Mailing Address - Fax:
Practice Address - Street 1:15 CONSTITUTION DR
Practice Address - Street 2:
Practice Address - City:BEDFORD
Practice Address - State:NH
Practice Address - Zip Code:03110-6042
Practice Address - Country:US
Practice Address - Phone:603-718-3939
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-12-04
Last Update Date:2025-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
No261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health