Healthcare Provider Details

I. General information

NPI: 1215079520
Provider Name (Legal Business Name): CHRISTOPHER CASAGRANDE
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/13/2007
Last Update Date: 12/13/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

140 QUEEN CITY AVE
MANCHESTER NH
03103-7122
US

IV. Provider business mailing address

1145 SAGAMORE AVE
PORTSMOUTH NH
03801-5585
US

V. Phone/Fax

Practice location:
  • Phone: 603-622-3020
  • Fax: 603-621-4295
Mailing address:
  • Phone: 603-431-6703
  • Fax: 603-430-3753

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number1049
License Number StateNH
# 2
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: