Healthcare Provider Details

I. General information

NPI: 1336895929
Provider Name (Legal Business Name): LILYPAD CLINICAL CHANGE & ADVOCACY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/23/2022
Last Update Date: 03/01/2022
Certification Date: 03/01/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

35A PISCATAQUA RD
DOVER NH
03820-5206
US

IV. Provider business mailing address

35A PISCATAQUA RD
DOVER NH
03820-5206
US

V. Phone/Fax

Practice location:
  • Phone: 603-475-7408
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name: MS. ALLISON CHRISTINE TOMPKINS
Title or Position: CO-OWNER
Credential: MSED., BCBA
Phone: 603-475-7408