Provider Demographics
NPI:1497084164
Name:MURTAGH, CAROL ANN (RNC,LADC)
Entity Type:Individual
Prefix:MRS
First Name:CAROL
Middle Name:ANN
Last Name:MURTAGH
Suffix:
Gender:F
Credentials:RNC,LADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:37 BOWMAN RD
Mailing Address - Street 2:PO BOX 1325
Mailing Address - City:ALTON
Mailing Address - State:NH
Mailing Address - Zip Code:03809-4700
Mailing Address - Country:US
Mailing Address - Phone:603-455-7779
Mailing Address - Fax:603-875-8294
Practice Address - Street 1:37 BOWMAN RD
Practice Address - Street 2:POST OFFICE BOX 1325
Practice Address - City:ALTON
Practice Address - State:NH
Practice Address - Zip Code:03809-4700
Practice Address - Country:US
Practice Address - Phone:603-455-7779
Practice Address - Fax:603-875-8294
Is Sole Proprietor?:Yes
Enumeration Date:2009-12-09
Last Update Date:2009-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH0499101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH8757717Medicaid
NH8757717Medicaid