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General NPI Number Information
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NPI Number | 1184489510
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Entity Type | Organization
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Legal Business Name | GRANITE STATE BEHAVIORAL HEALTH PLLC
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Dates
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Enumeration Date | 02/15/2024
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Last Update Date | 10/03/2024
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Provider Practice Location Address
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Address Line | 18 UNION ST
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City | WOLFEBORO
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State | NH
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Zip | 03894-4480
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Country | US
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Telephone | 603-515-1700
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 958
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City | WOLFEBORO FALLS
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State | NH
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Zip | 03896-0958
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Country | US
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Telephone | 603-515-1700
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Fax | 603-607-6472
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Authorized Official
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Title or Position | OWNER
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Name | MR. MATTHEW HERSEY
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Credential | APRN
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Telephone | 603-515-1700
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number |
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License Number State |
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