Provider Demographics
NPI:1093963977
Name:GRANITE STATE CHILD & FAMILY COUNSELING, PLLC
Entity Type:Organization
Organization Name:GRANITE STATE CHILD & FAMILY COUNSELING, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:LYNNE
Authorized Official - Middle Name:M
Authorized Official - Last Name:DUVAL
Authorized Official - Suffix:
Authorized Official - Credentials:LICSW
Authorized Official - Phone:603-672-1881
Mailing Address - Street 1:468 ROUTE 13 S
Mailing Address - Street 2:
Mailing Address - City:MILFORD
Mailing Address - State:NH
Mailing Address - Zip Code:03055-3488
Mailing Address - Country:US
Mailing Address - Phone:603-672-1881
Mailing Address - Fax:603-672-1444
Practice Address - Street 1:468 ROUTE 13 S
Practice Address - Street 2:
Practice Address - City:MILFORD
Practice Address - State:NH
Practice Address - Zip Code:03055-3488
Practice Address - Country:US
Practice Address - Phone:603-672-1881
Practice Address - Fax:603-672-1444
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-09-03
Last Update Date:2013-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH12071041C0700X
NH32106H00000X
NH87106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
9511074OtherAETNA
14Y001736NH02OtherANTHEM BCBS
378707OtherMVP
351210OtherMHN/TRICARE
378707OtherMVP