Healthcare Provider Details

I. General information

NPI: 1073527537
Provider Name (Legal Business Name): WILLIAM JOSEPH MANSEAU D.MIN.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/28/2006
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

154 BROAD ST
NASHUA NH
03063-3205
US

IV. Provider business mailing address

12 CATHERWOOD ST
TEWKSBURY MA
01876-2620
US

V. Phone/Fax

Practice location:
  • Phone: 603-886-3760
  • Fax: 603-821-6142
Mailing address:
  • Phone: 603-886-3760
  • Fax: 603-821-6142

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP1600X
TaxonomyPastoral Counselor
License Number40
License Number StateNH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: