Provider Demographics
NPI:1417367426
Name:AVERY PSYCHOLOGICAL SERVICES PA
Entity Type:Organization
Organization Name:AVERY PSYCHOLOGICAL SERVICES PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ANNE
Authorized Official - Middle Name:CONVERSE
Authorized Official - Last Name:AVERY
Authorized Official - Suffix:
Authorized Official - Credentials:EDD
Authorized Official - Phone:603-868-8100
Mailing Address - Street 1:27 BAGDAD RD
Mailing Address - Street 2:
Mailing Address - City:DURHAM
Mailing Address - State:NH
Mailing Address - Zip Code:03824-2201
Mailing Address - Country:US
Mailing Address - Phone:603-868-8100
Mailing Address - Fax:603-868-1330
Practice Address - Street 1:27 BAGDAD RD
Practice Address - Street 2:
Practice Address - City:DURHAM
Practice Address - State:NH
Practice Address - Zip Code:03824-2201
Practice Address - Country:US
Practice Address - Phone:603-868-8100
Practice Address - Fax:603-868-1330
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-04-29
Last Update Date:2015-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH702103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounselingGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA30010879Medicaid
NH30424491Medicaid