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General NPI Number Information
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NPI Number | 1477636546
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Entity Type | Individual
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Provider Name | EMILY BERNICE GEOGHEGAN M.DIV., PH.D.
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Gender | Female
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Dates
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Enumeration Date | 10/23/2006
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Last Update Date | 07/09/2007
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Provider Practice Location Address
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Address Line | 2013 ELM ST
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City | MANCHESTER
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State | NH
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Zip | 03104-2528
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Country | US
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Telephone | 603-627-2702
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Fax | 603-627-3643
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Provider Business Mailing Address
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Address Line | 110 SOUTH ST
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City | CONCORD
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State | NH
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Zip | 03301-2834
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Country | US
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Telephone | 603-627-2702
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Fax | 603-627-3643
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | 992
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License Number State | NH
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