=====================================================
General NPI Number Information
=====================================================
NPI Number | 1881052140
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | CAPITOL PSYCHOLOGY SERVICES, PLLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/02/2016
-----------------------------------------------------
Last Update Date | 02/02/2016
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 50 PLEASANT ST
-----------------------------------------------------
City | CONCORD
-----------------------------------------------------
State | NH
-----------------------------------------------------
Zip | 03301-4073
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 603-545-8355
-----------------------------------------------------
Fax | 603-715-2121
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 50 PLEASANT ST
-----------------------------------------------------
City | CONCORD
-----------------------------------------------------
State | NH
-----------------------------------------------------
Zip | 03301-4073
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 603-545-8355
-----------------------------------------------------
Fax | 603-715-2121
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | SOLE PROPRIETOR
-----------------------------------------------------
Name | DENISE LEVILLE
-----------------------------------------------------
Credential | PH . D
-----------------------------------------------------
Telephone | 603-545-8355
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 103TC0700X
-----------------------------------------------------
Taxonomy Name | Clinical Psychologist
-----------------------------------------------------
License Number | 1156
-----------------------------------------------------
License Number State | NH
-----------------------------------------------------