Healthcare Provider Details

I. General information

NPI: 1619368156
Provider Name (Legal Business Name): BENOIT FAMILY COUNSELING, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/05/2015
Last Update Date: 02/05/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10 FERRY ST SUTIE 412
CONCORD NH
03301-5022
US

IV. Provider business mailing address

78 BROOKSIDE LN
DANBURY NH
03230-4827
US

V. Phone/Fax

Practice location:
  • Phone: 603-440-8219
  • Fax:
Mailing address:
  • Phone: 603-440-8219
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number1324
License Number StateNH

VIII. Authorized Official

Name: RONALD BENOIT
Title or Position: CLINICIAN
Credential: LICSW
Phone: 603-440-8219