Provider Demographics
NPI:1427591148
Name:BORTNICK, GEORGE II (PHD, MLADC)
Entity Type:Individual
Prefix:DR
First Name:GEORGE
Middle Name:
Last Name:BORTNICK
Suffix:II
Gender:M
Credentials:PHD, MLADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9 LOON AVE
Mailing Address - Street 2:
Mailing Address - City:CONCORD
Mailing Address - State:NH
Mailing Address - Zip Code:03303-3506
Mailing Address - Country:US
Mailing Address - Phone:603-568-2284
Mailing Address - Fax:
Practice Address - Street 1:10 BRICKETTS MILL RD # A
Practice Address - Street 2:
Practice Address - City:HAMPSTEAD
Practice Address - State:NH
Practice Address - Zip Code:03841-2396
Practice Address - Country:US
Practice Address - Phone:603-568-2284
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-11-29
Last Update Date:2016-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH1011101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)