MEDICARE: AVERY PSYCHOLOGICAL SERVICES PA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103TC1900X	Counseling Psychologist	702	NH

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1417367426
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	AVERY PSYCHOLOGICAL SERVICES PA

Provider Business Mailing Address
First Line	:	27 BAGDAD RD
Second Line	:
City	:	DURHAM
State	:	NH
Zip	:	03824-2201
Country	:	US
Telephone Number	:	603-868-8100
Fax Number	:	603-868-1330

Provider Business Practice Location Address
First Line	:	27 BAGDAD RD
Second Line	:
City	:	DURHAM
State	:	NH
Zip	:	03824-2201
Country	:	US
Telephone Number	:	603-868-8100
Fax Number	:	603-868-1330

Authorized Official
Title or Position	:	PRESIDENT/OWNER
Name	:	DR. ANNE CONVERSE AVERY
Credential	:	EDD
Telephone Number	:	603-868-8100

Provider Enumeration Date	:	04/29/2014
Last Update Date	:	01/12/2015

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Directions to “AVERY PSYCHOLOGICAL SERVICES PA ” Practice Location

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