Healthcare Provider Details

I. General information

NPI: 1003066465
Provider Name (Legal Business Name): JULIA ELIZABETH GAMACHE MSW, MLADC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/23/2008
Last Update Date: 12/10/2020
Certification Date: 12/10/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1193 HOOKSETT RD STE 2
HOOKSETT NH
03106-1091
US

IV. Provider business mailing address

1193 HOOKSETT RD STE 2
HOOKSETT NH
03106-1091
US

V. Phone/Fax

Practice location:
  • Phone: 603-777-0361
  • Fax: 603-413-4633
Mailing address:
  • Phone: 603-777-0361
  • Fax: 603-413-4633

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number0652
License Number StateNH

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: