Provider Demographics
NPI:1760157515
Name:MISTRY, PAYAL (MA, R-DMT)
Entity Type:Individual
Prefix:
First Name:PAYAL
Middle Name:
Last Name:MISTRY
Suffix:
Gender:F
Credentials:MA, R-DMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:40 AVON ST
Mailing Address - Street 2:
Mailing Address - City:KEENE
Mailing Address - State:NH
Mailing Address - Zip Code:03431-3516
Mailing Address - Country:US
Mailing Address - Phone:603-283-1570
Mailing Address - Fax:
Practice Address - Street 1:40 AVON ST
Practice Address - Street 2:
Practice Address - City:KEENE
Practice Address - State:NH
Practice Address - Zip Code:03431-3516
Practice Address - Country:US
Practice Address - Phone:603-283-1570
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-08-13
Last Update Date:2024-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health