Provider Demographics
NPI:1588968838
Name:NEW ENGLAND INSTITUTE FOR MARRIAGE AND FAMILY THERAPY, PLLC
Entity type:Organization
Organization Name:NEW ENGLAND INSTITUTE FOR MARRIAGE AND FAMILY THERAPY, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:EVAN
Authorized Official - Middle Name:A
Authorized Official - Last Name:SORENSEN
Authorized Official - Suffix:
Authorized Official - Credentials:MS LMFT
Authorized Official - Phone:603-819-3816
Mailing Address - Street 1:116 S RIVER RD
Mailing Address - Street 2:BLDG E, 2ND FLOOR
Mailing Address - City:BEDFORD
Mailing Address - State:NH
Mailing Address - Zip Code:03110-6734
Mailing Address - Country:US
Mailing Address - Phone:603-819-3816
Mailing Address - Fax:603-329-5197
Practice Address - Street 1:116 S RIVER RD
Practice Address - Street 2:BLDG E, 2ND FLOOR
Practice Address - City:BEDFORD
Practice Address - State:NH
Practice Address - Zip Code:03110-6734
Practice Address - Country:US
Practice Address - Phone:603-819-3816
Practice Address - Fax:603-329-5197
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-12-30
Last Update Date:2010-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH77106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty