Healthcare Provider Details

I. General information

NPI: 1134691785
Provider Name (Legal Business Name): GREENGARD CENTER FOR AUTISM
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/20/2018
Last Update Date: 12/20/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

95 BREWERY LANE
PORTSMOUTH NH
03801
US

IV. Provider business mailing address

95 BREWERY LANE
PORTSMOUTH NH
03801
US

V. Phone/Fax

Practice location:
  • Phone: 603-501-0686
  • Fax: 603-380-7129
Mailing address:
  • Phone: 603-501-0686
  • Fax: 603-380-7129

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code252Y00000X
TaxonomyEarly Intervention Provider Agency
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code251C00000X
TaxonomyDevelopmentally Disabled Services Day Training Agency
License Number
License Number State

VIII. Authorized Official

Name: DR. BARBARA R FRANKEL
Title or Position: EXECUTIVE DIRECTOR
Credential: PH.D.
Phone: 603-501-0686