Healthcare Provider Details

I. General information

NPI: 1407109929
Provider Name (Legal Business Name): CAROLINE JULIA SCHIEK GAMBLE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/22/2012
Last Update Date: 09/12/2021
Certification Date: 09/03/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

250 COMMERCIAL ST STE 3004
MANCHESTER NH
03101-1118
US

IV. Provider business mailing address

9 DEVONSHIRE WAY
BEDFORD NH
03110-6211
US

V. Phone/Fax

Practice location:
  • Phone: 603-668-3050
  • Fax: 603-668-8666
Mailing address:
  • Phone: 516-765-0855
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number1539
License Number StateNH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: