Healthcare Provider Details

I. General information

NPI: 1508341595
Provider Name (Legal Business Name): AMY BILODEAU
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/26/2018
Last Update Date: 12/14/2023
Certification Date: 12/14/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

25 OLD DOVER RD
ROCHESTER NH
03867-3464
US

IV. Provider business mailing address

113 CROSBY RD STE 1
DOVER NH
03820-4370
US

V. Phone/Fax

Practice location:
  • Phone: 603-516-9300
  • Fax: 603-740-9179
Mailing address:
  • Phone: 603-516-9300
  • Fax: 603-740-9179

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number2565
License Number StateNH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: