Provider Demographics
NPI:1780681957
Name:DADEKIAN, MAUREEN ANN (LCMHC)
Entity Type:Individual
Prefix:MS
First Name:MAUREEN
Middle Name:ANN
Last Name:DADEKIAN
Suffix:
Gender:F
Credentials:LCMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 539
Mailing Address - Street 2:2 MARSHALL RD.
Mailing Address - City:KINGSTON
Mailing Address - State:NH
Mailing Address - Zip Code:03848-0539
Mailing Address - Country:US
Mailing Address - Phone:603-770-7751
Mailing Address - Fax:
Practice Address - Street 1:2 MARSHALL RD
Practice Address - Street 2:
Practice Address - City:KINGSTON
Practice Address - State:NH
Practice Address - Zip Code:03848-3020
Practice Address - Country:US
Practice Address - Phone:603-770-7751
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-04
Last Update Date:2015-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH181101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH30011428Medicaid