Healthcare Provider Details

I. General information

NPI: 1790706059
Provider Name (Legal Business Name): CENTER FOR EATING DISORDERS MANAGEMENT INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/22/2006
Last Update Date: 03/23/2023
Certification Date: 03/23/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

360 ROUTE 101 STE 10
BEDFORD NH
03110-5031
US

IV. Provider business mailing address

360 ROUTE 101 STE 10
BEDFORD NH
03110-5031
US

V. Phone/Fax

Practice location:
  • Phone: 603-472-2846
  • Fax: 603-472-2872
Mailing address:
  • Phone: 603-472-2846
  • Fax: 603-472-2872

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number890
License Number StateNH
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number720
License Number StateNH
# 3
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number1122
License Number StateNH
# 4
Primary TaxonomyN
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number
License Number State
# 6
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number068326-23
License Number StateNH
# 7
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number015394-23
License Number StateNH
# 8
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number057948-23
License Number StateNH
# 9
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number045324-23
License Number StateNH
# 10
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State

VIII. Authorized Official

Name: KRISTEN SCHEEL
Title or Position: DIRECTOR, TREASURER, SECRETARY
Credential:
Phone: 252-733-7374