Provider Demographics
NPI:1316391980
Name:JOHN M IUDICE
Entity Type:Organization
Organization Name:JOHN M IUDICE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:M
Authorized Official - Last Name:IUDICE
Authorized Official - Suffix:
Authorized Official - Credentials:LICSW, MLADC
Authorized Official - Phone:603-591-3707
Mailing Address - Street 1:14 MANCHESTER SQ
Mailing Address - Street 2:290
Mailing Address - City:PORTSMOUTH
Mailing Address - State:NH
Mailing Address - Zip Code:03801-8001
Mailing Address - Country:US
Mailing Address - Phone:603-591-3707
Mailing Address - Fax:603-583-5391
Practice Address - Street 1:14 MANCHESTER SQ
Practice Address - Street 2:290
Practice Address - City:PORTSMOUTH
Practice Address - State:NH
Practice Address - Zip Code:03801-8001
Practice Address - Country:US
Practice Address - Phone:603-591-3707
Practice Address - Fax:603-583-5391
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-04-20
Last Update Date:2016-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH16371041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty