Healthcare Provider Details

I. General information

NPI: 1124215439
Provider Name (Legal Business Name): MILFORD REGIONAL COUNSELING SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/01/2007
Last Update Date: 12/10/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15 UNION ST.
MILFORD NH
03055
US

IV. Provider business mailing address

15 UNION ST.
MILFORD NH
03055
US

V. Phone/Fax

Practice location:
  • Phone: 603-673-2508
  • Fax: 603-673-2712
Mailing address:
  • Phone: 603-673-2508
  • Fax: 603-673-2712

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name: MR. PETER KELLEHER
Title or Position: CEO
Credential:
Phone: 603-882-3616