Provider Demographics
NPI:1578560603
Name:AVERY, ANNE CONVERSE (EDD)
Entity Type:Individual
Prefix:DR
First Name:ANNE
Middle Name:CONVERSE
Last Name:AVERY
Suffix:
Gender:F
Credentials:EDD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:27 BAGDAD RD
Mailing Address - Street 2:
Mailing Address - City:DURHAM
Mailing Address - State:NH
Mailing Address - Zip Code:03824-2201
Mailing Address - Country:US
Mailing Address - Phone:603-868-8100
Mailing Address - Fax:
Practice Address - Street 1:27 BAGDAD RD
Practice Address - Street 2:
Practice Address - City:DURHAM
Practice Address - State:NH
Practice Address - Zip Code:03824-2201
Practice Address - Country:US
Practice Address - Phone:603-868-8100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-07-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH702103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling