Provider Demographics
NPI:1740615335
Name:DUNHAM, HEIDI L (PSYD)
Entity Type:Individual
Prefix:
First Name:HEIDI
Middle Name:L
Last Name:DUNHAM
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:514 SOUTH ST
Mailing Address - Street 2:
Mailing Address - City:BOW
Mailing Address - State:NH
Mailing Address - Zip Code:03304-3419
Mailing Address - Country:US
Mailing Address - Phone:603-410-5551
Mailing Address - Fax:
Practice Address - Street 1:187 N STATE ST
Practice Address - Street 2:
Practice Address - City:CONCORD
Practice Address - State:NH
Practice Address - Zip Code:03301-5020
Practice Address - Country:US
Practice Address - Phone:603-856-8163
Practice Address - Fax:603-856-8164
Is Sole Proprietor?:No
Enumeration Date:2013-09-13
Last Update Date:2021-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH1418103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA1300881Medicaid