Provider Demographics
NPI:1558145839
Name:BIRCH HAVEN PSYCHOLOGICAL ASSOCIATES, P.L.L.C.
Entity Type:Organization
Organization Name:BIRCH HAVEN PSYCHOLOGICAL ASSOCIATES, P.L.L.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:DAISY
Authorized Official - Middle Name:
Authorized Official - Last Name:CASSIDY
Authorized Official - Suffix:
Authorized Official - Credentials:LICSW
Authorized Official - Phone:978-482-7571
Mailing Address - Street 1:20 PORTSMOUTH AVE STE 1
Mailing Address - Street 2:PMB 1006
Mailing Address - City:STRATHAM
Mailing Address - State:NH
Mailing Address - Zip Code:03885-6528
Mailing Address - Country:US
Mailing Address - Phone:978-482-7571
Mailing Address - Fax:
Practice Address - Street 1:472 HIGH ST STE 305
Practice Address - Street 2:
Practice Address - City:SOMERSWORTH
Practice Address - State:NH
Practice Address - Zip Code:03878-1012
Practice Address - Country:US
Practice Address - Phone:978-482-7571
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-08-21
Last Update Date:2023-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty
No103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounselingGroup - Multi-Specialty