Provider Demographics
NPI:1306320999
Name:THE MENTAL HEALTH CTR FOR SOUTHERN NEW HAMPSHIRE
Entity type:Organization
Organization Name:THE MENTAL HEALTH CTR FOR SOUTHERN NEW HAMPSHIRE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AR SUPERVISOR
Authorized Official - Prefix:
Authorized Official - First Name:JODY
Authorized Official - Middle Name:
Authorized Official - Last Name:MASSERO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:603-965-0722
Mailing Address - Street 1:10 TSIENNETO RD
Mailing Address - Street 2:
Mailing Address - City:DERRY
Mailing Address - State:NH
Mailing Address - Zip Code:03038-1505
Mailing Address - Country:US
Mailing Address - Phone:603-434-1577
Mailing Address - Fax:603-434-3101
Practice Address - Street 1:10 TSIENNETO RD
Practice Address - Street 2:
Practice Address - City:DERRY
Practice Address - State:NH
Practice Address - Zip Code:03038-1505
Practice Address - Country:US
Practice Address - Phone:603-434-1577
Practice Address - Fax:603-434-3101
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-09-19
Last Update Date:2018-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health