Provider Demographics
NPI:1396971792
Name:FAMILY THERAPY INSTITUTE OF SOUTHERN NEW HAMPSHIRE AT BEDFORD, INC.
Entity type:Organization
Organization Name:FAMILY THERAPY INSTITUTE OF SOUTHERN NEW HAMPSHIRE AT BEDFORD, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:CLYDE
Authorized Official - Last Name:GODDARD
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:603-629-9851
Mailing Address - Street 1:PO BOX 10575
Mailing Address - Street 2:
Mailing Address - City:BEDFORD
Mailing Address - State:NH
Mailing Address - Zip Code:03110
Mailing Address - Country:US
Mailing Address - Phone:603-629-9851
Mailing Address - Fax:603-472-5781
Practice Address - Street 1:66 PROSPECT ST
Practice Address - Street 2:
Practice Address - City:MANCHESTER
Practice Address - State:NH
Practice Address - Zip Code:03104-3506
Practice Address - Country:US
Practice Address - Phone:603-629-9851
Practice Address - Fax:603-472-5781
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-06-01
Last Update Date:2009-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty