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General NPI Number Information
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NPI Number | 1497099212
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Entity Type | Organization
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Legal Business Name | BEDFORD FAMILY THERAPY
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Dates
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Enumeration Date | 11/16/2012
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Last Update Date | 11/16/2012
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Provider Practice Location Address
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Address Line | 10 COMMERCE PARK N STE 1A
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City | BEDFORD
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State | NH
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Zip | 03110-6951
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Country | US
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Telephone | 603-606-1233
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Fax |
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Provider Business Mailing Address
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Address Line | 10 COMMERCE PARK N STE 1A
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City | BEDFORD
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State | NH
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Zip | 03110-6951
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Country | US
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Telephone | 603-606-1233
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Fax |
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | JESSICA INFANTE
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Credential |
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Telephone | 603-606-1233
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | 0820
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License Number State | NH
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Taxonomy #2
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 1684
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License Number State | NH
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