Healthcare Provider Details

I. General information

NPI: 1669842183
Provider Name (Legal Business Name): PHYLLIS CRAIG, PHD, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/26/2015
Last Update Date: 09/26/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

24 FRONT ST
EXETER NH
03833-2727
US

IV. Provider business mailing address

24 FRONT ST
EXETER NH
03833-2727
US

V. Phone/Fax

Practice location:
  • Phone: 603-778-0505
  • Fax: 603-772-6761
Mailing address:
  • Phone: 603-778-0505
  • Fax: 603-772-6761

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number1033
License Number StateNH

VIII. Authorized Official

Name: MS. PHYLLIS LEE CRAIG
Title or Position: PROVIDER
Credential: PHD
Phone: 603-778-0505