Provider Demographics
NPI:1003924747
Name:GILLIGAN, DEBRA (LCMHC)
Entity Type:Individual
Prefix:
First Name:DEBRA
Middle Name:
Last Name:GILLIGAN
Suffix:
Gender:F
Credentials:LCMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 163
Mailing Address - Street 2:
Mailing Address - City:NEW BOSTON
Mailing Address - State:NH
Mailing Address - Zip Code:03070-0163
Mailing Address - Country:US
Mailing Address - Phone:603-487-2665
Mailing Address - Fax:603-964-7152
Practice Address - Street 1:222 COURT ST
Practice Address - Street 2:
Practice Address - City:PORTSMOUTH
Practice Address - State:NH
Practice Address - Zip Code:03801-4416
Practice Address - Country:US
Practice Address - Phone:603-487-2246
Practice Address - Fax:603-964-7152
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-25
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH5841041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH366745OtherMHN
NH30423713Medicaid
NH14Y008615NH01OtherANTHEM BCBS NUMBER
NH2187705OtherCIGNA BEHAVIORAL HEALTH
NH7369626OtherAETNA