Provider Demographics
NPI:1376502716
Name:BAGSHAW, LINDA J (LCMHC)
Entity Type:Individual
Prefix:
First Name:LINDA
Middle Name:J
Last Name:BAGSHAW
Suffix:
Gender:F
Credentials:LCMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:445 CYPRESS ST
Mailing Address - Street 2:SUITE 8
Mailing Address - City:MANCHESTER
Mailing Address - State:NH
Mailing Address - Zip Code:03103-3600
Mailing Address - Country:US
Mailing Address - Phone:603-668-4079
Mailing Address - Fax:603-663-8605
Practice Address - Street 1:445 CYPRESS ST
Practice Address - Street 2:SUITE 8
Practice Address - City:MANCHESTER
Practice Address - State:NH
Practice Address - Zip Code:03103-3600
Practice Address - Country:US
Practice Address - Phone:603-668-4079
Practice Address - Fax:603-663-8605
Is Sole Proprietor?:No
Enumeration Date:2006-03-23
Last Update Date:2010-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH550101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH14Y008150NH01OtherANTHEM ACES #
NH387278OtherMVP PIN
NH2218716OtherCIGNA NH PIN
NH30423320Medicaid