Healthcare Provider Details

I. General information

NPI: 1124769872
Provider Name (Legal Business Name): MELISSA MAI STOUGHTON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/06/2022
Last Update Date: 04/06/2022
Certification Date: 04/06/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

30 TEMPLE ST STE 105
NASHUA NH
03060-2401
US

IV. Provider business mailing address

216 NATICOOK RD
MERRIMACK NH
03054-4601
US

V. Phone/Fax

Practice location:
  • Phone: 603-880-9880
  • Fax: 603-402-9727
Mailing address:
  • Phone: 661-754-0914
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: