Provider Demographics
NPI:1962573659
Name:WIZWER, SETH ADAM (LCMHC)
Entity type:Individual
Prefix:
First Name:SETH
Middle Name:ADAM
Last Name:WIZWER
Suffix:
Gender:M
Credentials:LCMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:38 GONET DR
Mailing Address - Street 2:
Mailing Address - City:NEWMARKET
Mailing Address - State:NH
Mailing Address - Zip Code:03857-1746
Mailing Address - Country:US
Mailing Address - Phone:603-767-1290
Mailing Address - Fax:
Practice Address - Street 1:65 MIDDLE ST
Practice Address - Street 2:
Practice Address - City:MANCHESTER
Practice Address - State:NH
Practice Address - Zip Code:03101-1905
Practice Address - Country:US
Practice Address - Phone:603-767-1290
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-13
Last Update Date:2017-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH642101YM0800X
MECC2999101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MECC2999OtherMAINE LICENSE NUMBER
NH642OtherLCMHC LICENSE NUMBER