Healthcare Provider Details

I. General information

NPI: 1730852286
Provider Name (Legal Business Name): KEVIN GERSH
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/30/2021
Last Update Date: 12/29/2022
Certification Date: 12/29/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

57 REGIONAL DR STE 7
CONCORD NH
03301-8518
US

IV. Provider business mailing address

57 REGIONAL DR STE 7
CONCORD NH
03301-8518
US

V. Phone/Fax

Practice location:
  • Phone: 603-224-7630
  • Fax: 603-410-1105
Mailing address:
  • Phone: 603-224-7630
  • Fax: 603-410-1105

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: CHRISTI HEATH
Title or Position: REGIONAL DIRECTOR OF OPERATIONS
Credential: BCBA
Phone: 603-387-3187