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General NPI Number Information
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NPI Number | 1134695976
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Entity Type | Organization
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Legal Business Name | DAVID J. CORRISS, PH.D., PLLC
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Dates
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Enumeration Date | 10/19/2018
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Last Update Date | 10/19/2018
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Provider Practice Location Address
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Address Line | 180 LOCUST STREET
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City | DOVER
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State | NH
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Zip | 03820-4033
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Country | US
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Telephone | 603-742-1373
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Fax | 603-742-1423
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Provider Business Mailing Address
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Address Line | 180 LOCUST STREET
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City | DOVER
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State | NH
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Zip | 03820-4033
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Country | US
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Telephone | 603-742-1373
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Fax | 603-742-1423
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Authorized Official
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Title or Position | PROVIDER
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Name | DAVID CORRISS
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Credential | PH.D.
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Telephone | 603-742-1373
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number |
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License Number State |
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