Healthcare Provider Details

I. General information

NPI: 1003000365
Provider Name (Legal Business Name): NASHUA YOUTH COUNCIL INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/30/2007
Last Update Date: 03/27/2023
Certification Date: 03/27/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

74 NORTHEASTERN BLVD STE 10A
NASHUA NH
03062-3142
US

IV. Provider business mailing address

74 NORTHEASTERN BLVD STE 10A
NASHUA NH
03062-3142
US

V. Phone/Fax

Practice location:
  • Phone: 603-889-1090
  • Fax: 603-598-1703
Mailing address:
  • Phone: 603-889-1090
  • Fax: 603-598-1703

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MS. CASEY CASTER
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 603-889-1090