Healthcare Provider Details

I. General information

NPI: 1902007677
Provider Name (Legal Business Name): NEURODEVELOPMENTAL INSTITUTE OF NEW HAMPSHIRE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/30/2007
Last Update Date: 03/12/2021
Certification Date: 03/12/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

171 LONDONDERRY TURNPIKE
HOOKSETT NH
03106
US

IV. Provider business mailing address

171 LONDONDERRY TURNPIKE
HOOKSETT NH
03106
US

V. Phone/Fax

Practice location:
  • Phone: 603-621-9870
  • Fax: 603-621-9875
Mailing address:
  • Phone: 603-621-9870
  • Fax: 603-621-9875

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103G00000X
TaxonomyClinical Neuropsychologist
License Number994
License Number StateNH
# 2
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number994
License Number StateNH

VIII. Authorized Official

Name: DR. SUSAN E MCLAUGHLIN-BELTZ
Title or Position: OWNER/PRESIDENT
Credential: PH.D.
Phone: 603-621-9870