Provider Demographics
NPI:1558572354
Name:KALIL, MARRIAH C (LMFT)
Entity Type:Individual
Prefix:
First Name:MARRIAH
Middle Name:C
Last Name:KALIL
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:113 CROSBY RD
Mailing Address - Street 2:
Mailing Address - City:DOVER
Mailing Address - State:NH
Mailing Address - Zip Code:03820-4370
Mailing Address - Country:US
Mailing Address - Phone:603-516-9300
Mailing Address - Fax:
Practice Address - Street 1:55 WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:DOVER
Practice Address - State:NH
Practice Address - Zip Code:03820-3809
Practice Address - Country:US
Practice Address - Phone:603-516-9300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-24
Last Update Date:2008-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH94106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH30931444Medicaid
NHRE6496Medicare ID - Type Unspecified