Healthcare Provider Details

I. General information

NPI: 1093852816
Provider Name (Legal Business Name): ELIZABETH D PANAGOULIS LCMHC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/31/2007
Last Update Date: 01/21/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

30 TEMPLE ST. SUITE # 105
NASHUA NH
03060
US

IV. Provider business mailing address

30 TEMPLE ST. SUITE # 105
NASHUA NH
03060
US

V. Phone/Fax

Practice location:
  • Phone: 603-880-9880
  • Fax:
Mailing address:
  • Phone: 603-880-9880
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number15
License Number StateNH
# 2
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number3330
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: