Provider Demographics
NPI:1518069822
Name:CEDARSTROM, HOLLY SAMAHA (LCMHC)
Entity Type:Individual
Prefix:
First Name:HOLLY
Middle Name:SAMAHA
Last Name:CEDARSTROM
Suffix:
Gender:F
Credentials:LCMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:50 EATON AVE
Mailing Address - Street 2:
Mailing Address - City:MEREDITH
Mailing Address - State:NH
Mailing Address - Zip Code:03253-6708
Mailing Address - Country:US
Mailing Address - Phone:603-270-8209
Mailing Address - Fax:603-270-8209
Practice Address - Street 1:248 DANIEL WEBSTER HIGHWAY
Practice Address - Street 2:
Practice Address - City:MEREDITH
Practice Address - State:NH
Practice Address - Zip Code:03253
Practice Address - Country:US
Practice Address - Phone:603-279-8209
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-05
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH26101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH30006873Medicaid