Healthcare Provider Details

I. General information

NPI: 1922674332
Provider Name (Legal Business Name): DESIREE LINCOURT RBT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/27/2021
Last Update Date: 06/23/2021
Certification Date: 06/22/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

155 MAIN DUNSTABLE RD STE 200
NASHUA NH
03060-3640
US

IV. Provider business mailing address

855 MAIN DUNSTABLE RD SUITE 200
NASHUA NH
03060
US

V. Phone/Fax

Practice location:
  • Phone: 855-959-4222
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberRBT-21-172835
License Number StateNH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: