Provider Demographics
NPI:1518304872
Name:DIALECTICAL AND COGNITIVE BEHAVIORAL THERAPY OF NH, PLLC
Entity Type:Organization
Organization Name:DIALECTICAL AND COGNITIVE BEHAVIORAL THERAPY OF NH, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:LISA
Authorized Official - Middle Name:A
Authorized Official - Last Name:LAWRY
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:603-937-0094
Mailing Address - Street 1:1321 WASHINGTON AVE
Mailing Address - Street 2:SUITE 304
Mailing Address - City:PORTLAND
Mailing Address - State:ME
Mailing Address - Zip Code:04103-3636
Mailing Address - Country:US
Mailing Address - Phone:323-723-2864
Mailing Address - Fax:
Practice Address - Street 1:1321 WASHINGTON AVE
Practice Address - Street 2:SUITE 304
Practice Address - City:PORTLAND
Practice Address - State:ME
Practice Address - Zip Code:04103-3636
Practice Address - Country:US
Practice Address - Phone:323-723-2864
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-05-28
Last Update Date:2013-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MELC1039251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health