Provider Demographics
NPI:1477614030
Name:BILDNER, CHERYL (PHD)
Entity Type:Individual
Prefix:DR
First Name:CHERYL
Middle Name:
Last Name:BILDNER
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:RR 1 BOX 175
Mailing Address - Street 2:84 ELLIS RIDGE ROAD
Mailing Address - City:GLEN
Mailing Address - State:NH
Mailing Address - Zip Code:03838-7600
Mailing Address - Country:US
Mailing Address - Phone:603-383-8228
Mailing Address - Fax:
Practice Address - Street 1:81 WASHINGTON STREET, BOX 2726
Practice Address - Street 2:
Practice Address - City:CONWAY
Practice Address - State:NH
Practice Address - Zip Code:03818
Practice Address - Country:US
Practice Address - Phone:603-447-2453
Practice Address - Fax:603-447-2450
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH1055103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH06Y007925NH01OtherBILLING ID NUMBER
NH30423172Medicaid