Provider Demographics
NPI:1134695976
Name:DAVID J. CORRISS, PH.D., PLLC
Entity Type:Organization
Organization Name:DAVID J. CORRISS, PH.D., PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROVIDER
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:CORRISS
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:603-742-1373
Mailing Address - Street 1:180 LOCUST STREET
Mailing Address - Street 2:
Mailing Address - City:DOVER
Mailing Address - State:NH
Mailing Address - Zip Code:03820-4033
Mailing Address - Country:US
Mailing Address - Phone:603-742-1373
Mailing Address - Fax:603-742-1423
Practice Address - Street 1:180 LOCUST STREET
Practice Address - Street 2:
Practice Address - City:DOVER
Practice Address - State:NH
Practice Address - Zip Code:03820-4033
Practice Address - Country:US
Practice Address - Phone:603-742-1373
Practice Address - Fax:603-742-1423
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-10-19
Last Update Date:2018-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH3075304Medicaid