Provider Demographics
NPI:1275917353
Name:MCNAMARA, KAREN J (LADC, SAP, IDSP)
Entity Type:Individual
Prefix:
First Name:KAREN
Middle Name:J
Last Name:MCNAMARA
Suffix:
Gender:F
Credentials:LADC, SAP, IDSP
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 1268
Mailing Address - Street 2:
Mailing Address - City:LINCOLN
Mailing Address - State:NH
Mailing Address - Zip Code:03251-1268
Mailing Address - Country:US
Mailing Address - Phone:603-540-4644
Mailing Address - Fax:603-292-0131
Practice Address - Street 1:264 MAIN STREET
Practice Address - Street 2:BRIDGE PROJECT
Practice Address - City:LINCOLN
Practice Address - State:NH
Practice Address - Zip Code:03251
Practice Address - Country:US
Practice Address - Phone:603-540-4644
Practice Address - Fax:603-292-0131
Is Sole Proprietor?:Yes
Enumeration Date:2015-07-17
Last Update Date:2018-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH0390101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH3111116Medicaid
NH14089263OtherCAQH