Healthcare Provider Details

I. General information

NPI: 1417367426
Provider Name (Legal Business Name): AVERY PSYCHOLOGICAL SERVICES PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/29/2014
Last Update Date: 01/12/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

27 BAGDAD RD
DURHAM NH
03824-2201
US

IV. Provider business mailing address

27 BAGDAD RD
DURHAM NH
03824-2201
US

V. Phone/Fax

Practice location:
  • Phone: 603-868-8100
  • Fax: 603-868-1330
Mailing address:
  • Phone: 603-868-8100
  • Fax: 603-868-1330

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License Number702
License Number StateNH

VIII. Authorized Official

Name: DR. ANNE CONVERSE AVERY
Title or Position: PRESIDENT/OWNER
Credential: EDD
Phone: 603-868-8100