Provider Demographics
NPI:1760158125
Name:DUMONT, KARINEH ANNE
Entity Type:Individual
Prefix:
First Name:KARINEH
Middle Name:ANNE
Last Name:DUMONT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:90 BROADWAY
Mailing Address - Street 2:
Mailing Address - City:DOVER
Mailing Address - State:NH
Mailing Address - Zip Code:03820-3227
Mailing Address - Country:US
Mailing Address - Phone:757-603-0317
Mailing Address - Fax:
Practice Address - Street 1:100 MAIN ST STE 100
Practice Address - Street 2:
Practice Address - City:DOVER
Practice Address - State:NH
Practice Address - Zip Code:03820-3835
Practice Address - Country:US
Practice Address - Phone:603-812-5521
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-08-17
Last Update Date:2021-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RBT-21-178673106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician