Healthcare Provider Details

I. General information

NPI: 1578177044
Provider Name (Legal Business Name): MOIRA CHRISTINE DEBOIS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/02/2020
Last Update Date: 02/01/2021
Certification Date: 02/01/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2975 DARTMOUTH COLLEGE HWY STE 1
NORTH HAVERHILL NH
03774-4535
US

IV. Provider business mailing address

2975 DARTMOUTH COLLEGE HWY STE 1
NORTH HAVERHILL NH
03774-4535
US

V. Phone/Fax

Practice location:
  • Phone: 603-787-2150
  • Fax:
Mailing address:
  • Phone: 603-787-2150
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number54633
License Number StateNH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: