Healthcare Provider Details

I. General information

NPI: 1164672960
Provider Name (Legal Business Name): CELESTE ANN RICCI TRAHAN LICSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/29/2008
Last Update Date: 09/29/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9 ALEXIS LN
HAMPTON FALLS NH
03844-2106
US

IV. Provider business mailing address

9 ALEXIS LN
HAMPTON FALLS NH
03844-2106
US

V. Phone/Fax

Practice location:
  • Phone: 603-498-1210
  • Fax:
Mailing address:
  • Phone: 603-498-1210
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number1016728
License Number StateMA
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number1250
License Number StateNH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: