Healthcare Provider Details

I. General information

NPI: 1699460212
Provider Name (Legal Business Name): STEPHANIE O'SHAUGHNESSY LICSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/10/2023
Last Update Date: 12/20/2023
Certification Date: 12/20/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1600 WOODBURY AVE
PORTSMOUTH NH
03801-3250
US

IV. Provider business mailing address

360 US HIGHWAY 1 BYP UNIT 102
PORTSMOUTH NH
03801-7105
US

V. Phone/Fax

Practice location:
  • Phone: 603-602-9070
  • Fax: 603-810-6881
Mailing address:
  • Phone: 603-410-6700
  • Fax: 603-319-8308

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number2943
License Number StateNH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: