Healthcare Provider Details

I. General information

NPI: 1861815094
Provider Name (Legal Business Name): ENDURANCE BEHAVIORAL HEALTH PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/23/2014
Last Update Date: 05/29/2024
Certification Date: 05/29/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

823 LAFAYETTE RD
SEABROOK NH
03874-4215
US

IV. Provider business mailing address

PO BOX 2899
SEABROOK NH
03874-2899
US

V. Phone/Fax

Practice location:
  • Phone: 603-760-1942
  • Fax: 603-760-1949
Mailing address:
  • Phone: 603-918-4222
  • Fax: 603-760-1949

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC2200X
TaxonomyClinical Child & Adolescent Psychologist
License Number1292
License Number StateNH
# 2
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number314057
License Number StateMA

VIII. Authorized Official

Name: MR. CHRISTOPHER W WHITE
Title or Position: DIRECTOR OF OPERATIONS/MEMBER
Credential: LSW
Phone: 603-918-4222