Provider Demographics
NPI:1518056290
Name:DAVIES, JOHN D (LPP)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:D
Last Name:DAVIES
Suffix:
Gender:M
Credentials:LPP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:711 MT ISRAEL RD
Mailing Address - Street 2:
Mailing Address - City:CTR SANDWICH
Mailing Address - State:NH
Mailing Address - Zip Code:03227-3712
Mailing Address - Country:US
Mailing Address - Phone:603-591-2066
Mailing Address - Fax:603-284-6166
Practice Address - Street 1:4 POST OFFICE SQ
Practice Address - Street 2:
Practice Address - City:PLYMOUTH
Practice Address - State:NH
Practice Address - Zip Code:03264-1533
Practice Address - Country:US
Practice Address - Phone:603-591-2066
Practice Address - Fax:603-284-6166
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH62101YP1600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP1600XBehavioral Health & Social Service ProvidersCounselorPastoral
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH30423300Medicaid
NH65Y007735NH01OtherANTHEM