Healthcare Provider Details

I. General information

NPI: 1639638760
Provider Name (Legal Business Name): MATHEW HUUSKO IV CRSW
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/18/2019
Last Update Date: 03/18/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12 AMHERST ST
NASHUA NH
03064-2663
US

IV. Provider business mailing address

34 FRANKLIN ST STE LL13
NASHUA NH
03064-2686
US

V. Phone/Fax

Practice location:
  • Phone: 603-263-6444
  • Fax: 603-931-3719
Mailing address:
  • Phone: 603-343-6368
  • Fax: 603-617-2846

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number0176
License Number StateNH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: