Healthcare Provider Details

I. General information

NPI: 1386376648
Provider Name (Legal Business Name): PARADIGM BEHAVIORAL THERAPY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/27/2022
Last Update Date: 03/10/2023
Certification Date: 02/27/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19 WEYMOUTH DR
BEDFORD NH
03110-5025
US

IV. Provider business mailing address

19 WEYMOUTH DR
BEDFORD NH
03110-5025
US

V. Phone/Fax

Practice location:
  • Phone: 603-512-1075
  • Fax:
Mailing address:
  • Phone: 603-512-1075
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name: GARY G MCAREE
Title or Position: SOLE MBR
Credential: LCMHC, MLADC
Phone: 603-512-1075