Healthcare Provider Details

I. General information

NPI: 1083236988
Provider Name (Legal Business Name): FALLON FAMILY COUNSELING PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/13/2020
Last Update Date: 08/09/2020
Certification Date: 08/09/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

131 MAIN ST
EPPING NH
03042-2466
US

IV. Provider business mailing address

131 MAIN ST
EPPING NH
03042-2466
US

V. Phone/Fax

Practice location:
  • Phone: 603-682-8404
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: ANGELA CONSTANCE FALLON
Title or Position: SOCIAL WORKER
Credential: MSW
Phone: 603-682-8404