Healthcare Provider Details

I. General information

NPI: 1295639227
Provider Name (Legal Business Name): ANNA STACEY ROBERGE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/05/2026
Last Update Date: 10/05/2026
Certification Date: 10/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

71 MAIN STREET
ASHLAND NH
03217
US

IV. Provider business mailing address

69 BRECKENRIDGE WAY UNIT 13
LACONIA NH
03246-4025
US

V. Phone/Fax

Practice location:
  • Phone: 603-375-4312
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: