Healthcare Provider Details

I. General information

NPI: 1063464394
Provider Name (Legal Business Name): KARL ALAN BOISVERT M.A. LCMHC
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 05/16/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

278 PLEASANT STREET
CONCORD NH
03301
US

IV. Provider business mailing address

278 PLEASANT STREET
CONCORD NH
03301
US

V. Phone/Fax

Practice location:
  • Phone: 603-226-7570
  • Fax: 603-226-7526
Mailing address:
  • Phone: 603-226-7570
  • Fax: 603-226-7526

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number108
License Number StateNH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: