MEDICARE: PSYCHIATRIST HAMPSTEAD

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	2084P0804X	Child & Adolescent Psychiatry Physician
2	2084P0802X	Addiction Psychiatry Physician

General Provider Information

NPI Number	:	1528347663
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PSYCHIATRIST HAMPSTEAD

Provider Business Mailing Address
First Line	:	PO BOX 882
Second Line	:
City	:	PLAISTOW
State	:	NH
Zip	:	03865-0882
Country	:	US
Telephone Number	:	603-382-5400
Fax Number	:	603-382-4283

Provider Business Practice Location Address
First Line	:	218 EAST RD
Second Line	:
City	:	HAMPSTEAD
State	:	NH
Zip	:	03841-2305
Country	:	US
Telephone Number	:	603-329-5311
Fax Number	:	603-382-4283

Authorized Official
Title or Position	:	BILLING MANAGER
Name	:	MRS. DIANE E MCCORMACK
Credential	:
Telephone Number	:	603-382-5400

Provider Enumeration Date	:	08/08/2011
Last Update Date	:	08/08/2011

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1750656450 — PATRICIA E SHEA PSY.D.
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