MEDICARE: CROSSROADS COUNSELING CENTER, PLLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor

General Provider Information

NPI Number	:	1992850754
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CROSSROADS COUNSELING CENTER, PLLC

Provider Business Mailing Address
First Line	:	216 LAFAYETTE RD
Second Line	:	SUITE 206
City	:	NORTH HAMPTON
State	:	NH
Zip	:	03862-2445
Country	:	US
Telephone Number	:	603-964-1700
Fax Number	:	603-964-1701

Provider Business Practice Location Address
First Line	:	216 LAFAYETTE RD
Second Line	:	SUITE 206
City	:	NORTH HAMPTON
State	:	NH
Zip	:	03862-2445
Country	:	US
Telephone Number	:	603-964-1700
Fax Number	:	603-964-1701

Authorized Official
Title or Position	:	CO-MANAGER
Name	:	JANE C MARASCO
Credential	:	LICSW
Telephone Number	:	603-964-1700

Provider Enumeration Date	:	01/24/2007
Last Update Date	:	08/22/2020

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