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General NPI Number Information
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NPI Number | 1679967004
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Entity Type | Organization
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Legal Business Name | NEW ENGLAND PEDIATRIC SERVICES, LLC
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Dates
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Enumeration Date | 03/24/2015
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Last Update Date | 03/24/2015
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Provider Practice Location Address
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Address Line | 169 S RIVER RD UNIT 9
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City | BEDFORD
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State | NH
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Zip | 03110-6971
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Country | US
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Telephone | 603-296-5241
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Fax | 603-606-2443
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Provider Business Mailing Address
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Address Line | 169 S RIVER RD UNIT 9
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City | BEDFORD
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State | NH
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Zip | 03110-6971
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Country | US
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Telephone | 603-296-5241
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Fax | 603-606-2443
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Authorized Official
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Title or Position | CO-OWNER
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Name | ANNIE DIVELLO
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Credential | M.S.,CCC-SLP
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Telephone | 603-296-5241
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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 |
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License Number State |
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