Provider Demographics
NPI:1568057990
Name:MOUNT PROSPECT ACADEMY
Entity Type:Organization
Organization Name:MOUNT PROSPECT ACADEMY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF ACADEMICS
Authorized Official - Prefix:MR
Authorized Official - First Name:CORY
Authorized Official - Middle Name:A
Authorized Official - Last Name:ROGERS
Authorized Official - Suffix:
Authorized Official - Credentials:PRICIPAL
Authorized Official - Phone:603-762-5306
Mailing Address - Street 1:31 WASHINGTON ST
Mailing Address - Street 2:SUITE 224
Mailing Address - City:KEENE
Mailing Address - State:NH
Mailing Address - Zip Code:03431
Mailing Address - Country:US
Mailing Address - Phone:603-506-4665
Mailing Address - Fax:603-593-3134
Practice Address - Street 1:31 WASHINGTON ST
Practice Address - Street 2:SUITE 224
Practice Address - City:KEENE
Practice Address - State:NH
Practice Address - Zip Code:03431
Practice Address - Country:US
Practice Address - Phone:603-506-4665
Practice Address - Fax:603-593-3134
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MOUNT PROSPECT ACADEMY ASHUELOT VALLEY ACADEMY
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2021-03-08
Last Update Date:2021-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty