Provider Demographics
NPI:1528185790
Name:DUNN, MIRIAM
Entity Type:Individual
Prefix:
First Name:MIRIAM
Middle Name:
Last Name:DUNN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4 WINTER ST
Mailing Address - Street 2:
Mailing Address - City:PETERBOROUGH
Mailing Address - State:NH
Mailing Address - Zip Code:03458-1407
Mailing Address - Country:US
Mailing Address - Phone:603-924-6144
Mailing Address - Fax:603-889-4694
Practice Address - Street 1:491 AMHERST ST
Practice Address - Street 2:27
Practice Address - City:NASHUA
Practice Address - State:NH
Practice Address - Zip Code:03063-1259
Practice Address - Country:US
Practice Address - Phone:603-889-4694
Practice Address - Fax:603-889-4694
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH68106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH30422544Medicaid