Healthcare Provider Details

I. General information

NPI: 1053904888
Provider Name (Legal Business Name): LYDIA ZELLER NCSP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/12/2021
Last Update Date: 02/12/2021
Certification Date: 02/12/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

29 SCHOOL RD
LEMPSTER NH
03605-3500
US

IV. Provider business mailing address

806 N MAIN ST
LACONIA NH
03246-2603
US

V. Phone/Fax

Practice location:
  • Phone: 603-863-2420
  • Fax:
Mailing address:
  • Phone: 603-524-9090
  • Fax: 603-542-1497

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number129403
License Number StateNH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: