Healthcare Provider Details

I. General information

NPI: 1295923761
Provider Name (Legal Business Name): COCHECHO VALLEY MENTAL HEALTH
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/10/2007
Last Update Date: 10/10/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

90 WASHINGTON ST
DOVER NH
03820-3744
US

IV. Provider business mailing address

90 WASHINGTON ST
DOVER NH
03820-3744
US

V. Phone/Fax

Practice location:
  • Phone: 603-749-0992
  • Fax:
Mailing address:
  • Phone: 603-749-0992
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number355
License Number StateNH

VIII. Authorized Official

Name: DR. CRAIG E. STENSLIE
Title or Position: PARTNER
Credential:
Phone: 603-749-0992