Provider Demographics
NPI:1407133226
Name:TOLSTIKOVA, EKATERINA (PHD)
Entity Type:Individual
Prefix:DR
First Name:EKATERINA
Middle Name:
Last Name:TOLSTIKOVA
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:DR
Other - First Name:KATERINA
Other - Middle Name:
Other - Last Name:TOLSTIKOVA
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PHD
Mailing Address - Street 1:150 MYRTLE ST
Mailing Address - Street 2:
Mailing Address - City:MANCHESTER
Mailing Address - State:NH
Mailing Address - Zip Code:03104-6025
Mailing Address - Country:US
Mailing Address - Phone:603-206-5844
Mailing Address - Fax:603-386-7007
Practice Address - Street 1:150 MYRTLE STREET
Practice Address - Street 2:
Practice Address - City:MANCHESTER
Practice Address - State:NH
Practice Address - Zip Code:03104-6025
Practice Address - Country:US
Practice Address - Phone:603-213-0700
Practice Address - Fax:603-386-7007
Is Sole Proprietor?:Yes
Enumeration Date:2011-11-08
Last Update Date:2023-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH1284103T00000X, 103G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist