Provider Demographics
NPI:1447393087
Name:GLENGAYNOR PSYCHOTHERAPY PRACTICE, LLC
Entity Type:Organization
Organization Name:GLENGAYNOR PSYCHOTHERAPY PRACTICE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHIATRIC NURSE PRACTITIONER
Authorized Official - Prefix:MR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:JOHN
Authorized Official - Last Name:GAYNOR
Authorized Official - Suffix:
Authorized Official - Credentials:ARNP
Authorized Official - Phone:603-863-7142
Mailing Address - Street 1:PO BOX 272
Mailing Address - Street 2:SAWYER BROOK PLAZA - SUITE 10
Mailing Address - City:GRANTHAM
Mailing Address - State:NH
Mailing Address - Zip Code:03753-0272
Mailing Address - Country:US
Mailing Address - Phone:603-863-3788
Mailing Address - Fax:603-863-2753
Practice Address - Street 1:120 ROUTE 10
Practice Address - Street 2:SAWYER BROOK PLAZA-SUITE 10
Practice Address - City:GRANTHAM
Practice Address - State:NH
Practice Address - Zip Code:03753
Practice Address - Country:US
Practice Address - Phone:603-863-3788
Practice Address - Fax:603-863-2753
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-14
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH049181-23-08363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty