Healthcare Provider Details

I. General information

NPI: 1891325437
Provider Name (Legal Business Name): REBECCA KISAKYE MSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: REBECCA SKAHAN MSW

II. Dates (important events)

Enumeration Date: 01/23/2020
Last Update Date: 07/09/2026
Certification Date: 07/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

75 PARKSIDE AVE
MANCHESTER NH
03102-3603
US

IV. Provider business mailing address

145 HOLLIS ST
MANCHESTER NH
03101-1235
US

V. Phone/Fax

Practice location:
  • Phone: 603-626-9500
  • Fax: 833-448-1486
Mailing address:
  • Phone: 603-626-9500
  • Fax: 833-448-1486

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: