=====================================================
General NPI Number Information
=====================================================
NPI Number | 1215297197
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | THE FRONT DOOR AGENCY
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/24/2012
-----------------------------------------------------
Last Update Date | 05/24/2012
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 7 CONCORD ST
-----------------------------------------------------
City | NASHUA
-----------------------------------------------------
State | NH
-----------------------------------------------------
Zip | 03064-2328
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 603-886-2866
-----------------------------------------------------
Fax | 603-886-9214
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 7 CONCORD ST
-----------------------------------------------------
City | NASHUA
-----------------------------------------------------
State | NH
-----------------------------------------------------
Zip | 03064-2328
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 603-886-2866
-----------------------------------------------------
Fax | 603-886-9214
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | BUSINESS MANAGER
-----------------------------------------------------
Name | MRS. CYNTHIA S DELLACAMERA
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 603-816-0292
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101YA0400X
-----------------------------------------------------
Taxonomy Name | Addiction (Substance Use Disorder) Counselor
-----------------------------------------------------
License Number | 901
-----------------------------------------------------
License Number State | NH
-----------------------------------------------------