Provider Demographics
NPI:1588790539
Name:SHORT, MARY E (LCMHC, MLADC)
Entity type:Individual
Prefix:MS
First Name:MARY
Middle Name:E
Last Name:SHORT
Suffix:
Gender:F
Credentials:LCMHC, MLADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:87 STILES RD
Mailing Address - Street 2:SUITE 106
Mailing Address - City:SALEM
Mailing Address - State:NH
Mailing Address - Zip Code:03079-2899
Mailing Address - Country:US
Mailing Address - Phone:603-893-7700
Mailing Address - Fax:603-893-7331
Practice Address - Street 1:87 STILES RD
Practice Address - Street 2:SUITE 106
Practice Address - City:SALEM
Practice Address - State:NH
Practice Address - Zip Code:03079-2899
Practice Address - Country:US
Practice Address - Phone:603-893-7700
Practice Address - Fax:603-893-7331
Is Sole Proprietor?:No
Enumeration Date:2007-02-26
Last Update Date:2012-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH743101YM0800X
NH882101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)