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General NPI Number Information
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NPI Number | 1760964639
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Entity Type | Organization
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Legal Business Name | CAROL L MANDIGO LICSW LLC
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Dates
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Enumeration Date | 09/06/2018
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Last Update Date | 09/10/2018
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Provider Practice Location Address
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Address Line | 83 CLINTON ST
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City | CONCORD
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State | NH
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Zip | 03301-2262
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Country | US
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Telephone | 603-225-4400
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Fax | 603-226-0070
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Provider Business Mailing Address
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Address Line | 83 CLINTON ST
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City | CONCORD
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State | NH
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Zip | 03301-2262
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Country | US
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Telephone | 603-225-4400
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Fax | 603-226-0070
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Authorized Official
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Title or Position | OWNER
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Name | CAROL MANDIGO
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Credential | LICSW
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Telephone | 603-225-4400
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 104100000X
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Taxonomy Name | Social Worker
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License Number | NH372
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License Number State | NH
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