MEDICARE: DR. ANNE CONVERSE AVERY ED.D.

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

General Provider Information

NPI Number	:	1578560603
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ANNE CONVERSE AVERY ED.D.

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	:

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	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/05/2005
Last Update Date	:	07/08/2007

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