Healthcare Provider Details

I. General information

NPI: 1386853257
Provider Name (Legal Business Name): PAUL JOSEPH CODY PH.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/21/2007
Last Update Date: 03/17/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

38 S MAIN ST
CONCORD NH
03301-4817
US

IV. Provider business mailing address

89 MAIN ST
PITTSFIELD NH
03263-3703
US

V. Phone/Fax

Practice location:
  • Phone: 603-225-2739
  • Fax: 603-228-6255
Mailing address:
  • Phone: 603-435-7552
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number555
License Number StateNH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: