MEDICARE: CHRISTY ANN CHARLESWORTH LCMHC

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	101YP2500X	Professional Counselor
2	101YM0800X	Mental Health Counselor	811	NH

General Provider Information

NPI Number	:	1780984708
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHRISTY ANN CHARLESWORTH LCMHC

Provider Business Mailing Address
First Line	:	445 CYPRESS ST STE 8
Second Line	:
City	:	MANCHESTER
State	:	NH
Zip	:	03103-3600
Country	:	US
Telephone Number	:	603-668-4079
Fax Number	:

Provider Business Practice Location Address
First Line	:	5 CHENELL DR STE 110
Second Line	:
City	:	CONCORD
State	:	NH
Zip	:	03301-8503
Country	:	US
Telephone Number	:	603-883-0005
Fax Number	:	603-883-0007

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

Provider Enumeration Date	:	10/25/2010
Last Update Date	:	05/26/2026

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