Healthcare Provider Details

I. General information

NPI: 1134838287
Provider Name (Legal Business Name): EILEEN ROSS, EDM, LCMHC, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/17/2022
Last Update Date: 04/29/2025
Certification Date: 04/29/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

132 PATTEN HILL RD
CANDIA NH
03034-2543
US

IV. Provider business mailing address

132 PATTEN HILL RD
CANDIA NH
03034-2543
US

V. Phone/Fax

Practice location:
  • Phone: 603-483-5105
  • Fax: 603-483-0855
Mailing address:
  • Phone: 603-483-5105
  • Fax: 603-483-0855

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State

VIII. Authorized Official

Name: MS. EILEEN ELIZABETH ROSS
Title or Position: MANAGER
Credential: EDM
Phone: 603-483-5105