Healthcare Provider Details

I. General information

NPI: 1912050311
Provider Name (Legal Business Name): PORTSMOUTH AND EXETER MENTAL HEALTH ASSOCIATES INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/19/2007
Last Update Date: 10/12/2022
Certification Date: 10/12/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 MARKET ST UNIT 1G
PORTSMOUTH NH
03801-3456
US

IV. Provider business mailing address

500 MARKET ST UNIT 1G
PORTSMOUTH NH
03801-3456
US

V. Phone/Fax

Practice location:
  • Phone: 603-433-2656
  • Fax: 603-433-2736
Mailing address:
  • Phone: 603-433-2656
  • Fax: 603-433-2736

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberNH 302
License Number StateNH
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberNH 235
License Number StateNH
# 3
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License NumberNH 1015
License Number StateNH
# 4
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License NumberNH 964
License Number StateNH
# 5
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberNH 165
License Number StateNH
# 6
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberNH161
License Number StateNH
# 7
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberNH 1149
License Number StateNH
# 8
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberNH 50
License Number StateNH
# 9
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberNH 9865
License Number StateNH
# 10
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name: RICHARD CARR
Title or Position: PRESIDENT
Credential:
Phone: 603-433-2656