Healthcare Provider Details

I. General information

NPI: 1467581033
Provider Name (Legal Business Name): CATHERINE GRACE HODGDON LMT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/02/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8 STILES RD SUITE 107
SALEM NH
03079-2847
US

IV. Provider business mailing address

120 HAMPSTEAD RD # B
DERRY NH
03038-7033
US

V. Phone/Fax

Practice location:
  • Phone: 603-890-9996
  • Fax:
Mailing address:
  • Phone: 603-434-9718
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171W00000X
TaxonomyContractor
License Number2366M
License Number StateNH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: