Healthcare Provider Details

I. General information

NPI: 1821922147
Provider Name (Legal Business Name): TEMPLE OF THE SOVEREIGN SELF LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/11/2026
Last Update Date: 06/11/2026
Certification Date: 05/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

37 BROCK STREET
ROCHESTER NH
03867
US

IV. Provider business mailing address

306 N MAIN ST STE 4
ROCHESTER NH
03867-4353
US

V. Phone/Fax

Practice location:
  • Phone: 603-767-3703
  • Fax:
Mailing address:
  • Phone: 603-767-3703
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name: MS. RACHEL ANNE SICARI
Title or Position: OWNER
Credential:
Phone: 603-767-3703