Healthcare Provider Details

I. General information

NPI: 1326426412
Provider Name (Legal Business Name): SUSAN FECTEAU GELINAS MSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/11/2015
Last Update Date: 05/11/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

111 CHURCH ST
LACONIA NH
03246-3432
US

IV. Provider business mailing address

111 CHURCH ST
LACONIA NH
03246-3432
US

V. Phone/Fax

Practice location:
  • Phone: 603-524-1100
  • Fax:
Mailing address:
  • Phone: 603-524-1100
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: