Provider Demographics
NPI: | 1306010459 |
---|---|
Name: | BOOTH, CATHY JAMES (CCC-SLP, BCBA) |
Entity Type: | Individual |
Prefix: | MS |
First Name: | CATHY |
Middle Name: | JAMES |
Last Name: | BOOTH |
Suffix: | |
Gender: | F |
Credentials: | CCC-SLP, BCBA |
Other - Prefix: | |
Other - First Name: | |
Other - Middle Name: | |
Other - Last Name: | |
Other - Suffix: | |
Other - Last Name Type: | |
Other - Credentials: | |
Mailing Address - Street 1: | 65 KINGSTON RD |
Mailing Address - Street 2: | |
Mailing Address - City: | PLAISTOW |
Mailing Address - State: | NH |
Mailing Address - Zip Code: | 03865-3043 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 603-382-8735 |
Mailing Address - Fax: | |
Practice Address - Street 1: | 65 KINGSTON RD |
Practice Address - Street 2: | |
Practice Address - City: | PLAISTOW |
Practice Address - State: | NH |
Practice Address - Zip Code: | 03865-3043 |
Practice Address - Country: | US |
Practice Address - Phone: | 603-382-8735 |
Practice Address - Fax: | |
Is Sole Proprietor?: | No |
Enumeration Date: | 2008-04-19 |
Last Update Date: | 2023-07-10 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
MA | 242 | 103K00000X |
1-07-3292 | 103K00000X | |
MA | 6723 | 235Z00000X |
NH | 0784 | 235Z00000X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization |
---|---|---|---|---|
Yes | 235Z00000X | Speech, Language and Hearing Service Providers | Speech-Language Pathologist | |
No | 103K00000X | Behavioral Health & Social Service Providers | Behavior Analyst |
Provider Identifiers
State | Identifier ID | ID Type | Issuer |
---|---|---|---|
NH | 66Y011066NH01 | Other | BLUE CROSS BLUE SHIELD |