Healthcare Provider Details

I. General information

NPI: 1558572354
Provider Name (Legal Business Name): MARRIAH C KALIL LMFT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/24/2007
Last Update Date: 09/30/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

55 WASHINGTON ST
DOVER NH
03820-3809
US

IV. Provider business mailing address

113 CROSBY RD
DOVER NH
03820-4370
US

V. Phone/Fax

Practice location:
  • Phone: 603-516-9300
  • Fax:
Mailing address:
  • Phone: 603-516-9300
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number94
License Number StateNH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: