Provider Demographics
NPI:1063464394
Name:BOISVERT, KARL ALAN (MA LCMHC)
Entity Type:Individual
Prefix:MR
First Name:KARL
Middle Name:ALAN
Last Name:BOISVERT
Suffix:
Gender:M
Credentials:MA LCMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:278 PLEASANT STREET
Mailing Address - Street 2:
Mailing Address - City:CONCORD
Mailing Address - State:NH
Mailing Address - Zip Code:03301
Mailing Address - Country:US
Mailing Address - Phone:603-226-7570
Mailing Address - Fax:603-226-7526
Practice Address - Street 1:278 PLEASANT STREET
Practice Address - Street 2:
Practice Address - City:CONCORD
Practice Address - State:NH
Practice Address - Zip Code:03301
Practice Address - Country:US
Practice Address - Phone:603-226-7570
Practice Address - Fax:603-226-7526
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH108101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health