Healthcare Provider Details

I. General information

NPI: 1306944467
Provider Name (Legal Business Name): CHRISTY J FIVGAS MSW, LICSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/20/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2013 ELM ST MANNING HOUSE, SECOND FLOOR
MANCHESTER NH
03104-2528
US

IV. Provider business mailing address

2013 ELM STREET MANNING HOUSE, SECOND FLOOR
MANCHESTER NH
03104
US

V. Phone/Fax

Practice location:
  • Phone: 603-627-2702
  • Fax: 603-627-3643
Mailing address:
  • Phone: 603-627-2702
  • Fax: 603-627-3643

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number1032
License Number StateNH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: