=====================================================
General NPI Number Information
=====================================================
NPI Number | 1386826188
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | THE COUPLES CENTER, PLLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/04/2007
-----------------------------------------------------
Last Update Date | 04/24/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 118 MAPLEWOOD AVE. BUILDING A
-----------------------------------------------------
City | PORTSMOUTH
-----------------------------------------------------
State | NH
-----------------------------------------------------
Zip | 03801-4304
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 603-431-7131
-----------------------------------------------------
Fax | 207-439-4113
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 118 MAPLEWOOD AVE BUILDING A
-----------------------------------------------------
City | PORTSMOUTH
-----------------------------------------------------
State | NH
-----------------------------------------------------
Zip | 03801-3787
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 603-431-7131
-----------------------------------------------------
Fax | 207-439-4113
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | MS. SUSAN RIVCHUN LAGER
-----------------------------------------------------
Credential | LICSW
-----------------------------------------------------
Telephone | 603-431-7131
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1041C0700X
-----------------------------------------------------
Taxonomy Name | Clinical Social Worker
-----------------------------------------------------
License Number | 202
-----------------------------------------------------
License Number State | NH
-----------------------------------------------------