Healthcare Provider Details

I. General information

NPI: 1831164219
Provider Name (Legal Business Name): LYNN A. VILLEMAIRE M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/21/2006
Last Update Date: 03/01/2024
Certification Date: 03/01/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

40 AVON ST
KEENE NH
03431-3516
US

IV. Provider business mailing address

64 MAIN ST FL 2
KEENE NH
03431-3701
US

V. Phone/Fax

Practice location:
  • Phone: 603-357-4400
  • Fax:
Mailing address:
  • Phone: 603-283-1574
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number234316
License Number StateMA
# 2
Primary TaxonomyN
Taxonomy Code2084P0805X
TaxonomyGeriatric Psychiatry Physician
License Number10379
License Number StateNH
# 3
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number2827287
License Number StateNH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: