=====================================================
General NPI Number Information
=====================================================
NPI Number | 1508401415
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | DEBORAH C. CHESHIRE, PSY.D, PLLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/14/2019
-----------------------------------------------------
Last Update Date | 11/14/2019
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 372 WEST ST STE 200
-----------------------------------------------------
City | KEENE
-----------------------------------------------------
State | NH
-----------------------------------------------------
Zip | 03431-2412
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 802-452-0241
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 16 SCOTT CIR
-----------------------------------------------------
City | SPOFFORD
-----------------------------------------------------
State | NH
-----------------------------------------------------
Zip | 03462-4631
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 979-422-6362
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CLINICAL PSYCHOLOGIST; OWNER
-----------------------------------------------------
Name | DR. DEBORAH C CHESHIRE
-----------------------------------------------------
Credential | PSY.D
-----------------------------------------------------
Telephone | 802-452-0241
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QM0850X
-----------------------------------------------------
Taxonomy Name | Adult Mental Health Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------