Provider Demographics
NPI:1720524929
Name:AXTMAN, PHOEBE E (LICSW, MLADC)
Entity type:Individual
Prefix:
First Name:PHOEBE
Middle Name:E
Last Name:AXTMAN
Suffix:
Gender:
Credentials:LICSW, MLADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22 BRIDGE ST STE 19
Mailing Address - Street 2:
Mailing Address - City:CONCORD
Mailing Address - State:NH
Mailing Address - Zip Code:03301-4987
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:22 BRIDGE STREET
Practice Address - Street 2:3RD FLOOR, SUITE B4
Practice Address - City:CONCORD
Practice Address - State:NH
Practice Address - Zip Code:03301-4987
Practice Address - Country:US
Practice Address - Phone:603-441-0600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-01-11
Last Update Date:2025-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH2835101YM0800X, 1041C0700X
NH1206101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH3134057Medicaid