Healthcare Provider Details

I. General information

NPI: 1902851298
Provider Name (Legal Business Name): SYDNEY CROTEAUGORTON LCMHC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/24/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

186 S COURT ST
WOODSVILLE NH
03785-1024
US

IV. Provider business mailing address

186 S COURT ST
WOODSVILLE NH
03785-1024
US

V. Phone/Fax

Practice location:
  • Phone: 603-747-4193
  • Fax: 603-747-4193
Mailing address:
  • Phone: 603-747-4193
  • Fax: 603-747-4193

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number121
License Number StateNH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: