Healthcare Provider Details

I. General information

NPI: 1114102464
Provider Name (Legal Business Name): CENTER FOR EATING DISORDERS MANAGEMENT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/07/2008
Last Update Date: 03/01/2023
Certification Date: 03/01/2023
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 Code133V00000X
TaxonomyRegistered Dietitian
License Number453
License Number StateNH
# 2
Primary TaxonomyN
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State

VIII. Authorized Official

Name: LAURA J CLAUSS
Title or Position: NURSE PRACTITIONER, PRESIDENT, CEO
Credential: ARNP-C, CEDS
Phone: 609-472-2846