Healthcare Provider Details

I. General information

NPI: 1205216892
Provider Name (Legal Business Name): REBECCA J ENSIGN MA, LCMHC, LCPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/09/2015
Last Update Date: 07/24/2024
Certification Date: 07/24/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

85 S RIVER RD STE 1 #1001
BEDFORD NH
03110-6774
US

IV. Provider business mailing address

85 S RIVER RD STE 1 #1001
BEDFORD NH
03110-6774
US

V. Phone/Fax

Practice location:
  • Phone: 603-718-3330
  • Fax:
Mailing address:
  • Phone: 603-718-3330
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number2343
License Number StateNH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: