Provider Demographics
NPI:1720018914
Name:THE BRICHEL CENTER, PROFESSIONAL ASSOCIATION
Entity Type:Organization
Organization Name:THE BRICHEL CENTER, PROFESSIONAL ASSOCIATION
Other - Org Name:BRICHEL CENTER FOR NEURODEVELOPMENT
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:CO-FOUNDER
Authorized Official - Prefix:DR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:THOMAS
Authorized Official - Last Name:MAUTZ
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:603-334-3311
Mailing Address - Street 1:20 LADD ST
Mailing Address - Street 2:4TH FLOOR
Mailing Address - City:PORTSMOUTH
Mailing Address - State:NH
Mailing Address - Zip Code:03801-4087
Mailing Address - Country:US
Mailing Address - Phone:603-334-3311
Mailing Address - Fax:603-433-6341
Practice Address - Street 1:20 LADD ST
Practice Address - Street 2:4TH FLOOR
Practice Address - City:PORTSMOUTH
Practice Address - State:NH
Practice Address - Zip Code:03801-4087
Practice Address - Country:US
Practice Address - Phone:603-334-3311
Practice Address - Fax:603-433-6341
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-03
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH963103TC0700X
NH1087103TC0700X
NH2031041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty
Not Answered1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty