Healthcare Provider Details

I. General information

NPI: 1285308882
Provider Name (Legal Business Name): RHEANNA JADE MABLE BSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/06/2021
Last Update Date: 08/18/2026
Certification Date: 08/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

105 LOUDON RD BLDG 3
CONCORD NH
03301-5600
US

IV. Provider business mailing address

PO BOX 2032
CONCORD NH
03302-2032
US

V. Phone/Fax

Practice location:
  • Phone: 603-280-5472
  • Fax:
Mailing address:
  • Phone: 603-226-7505
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number5891
License Number StateNH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: