Provider Demographics
NPI:1891143939
Name:CORE ATTACHMENT THERAPY, LLC
Entity Type:Organization
Organization Name:CORE ATTACHMENT THERAPY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:MS
Authorized Official - First Name:DOROTHY
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:DERAPELIAN
Authorized Official - Suffix:
Authorized Official - Credentials:MED,LCMHC
Authorized Official - Phone:603-279-8169
Mailing Address - Street 1:PO BOX 334
Mailing Address - Street 2:
Mailing Address - City:MEREDITH
Mailing Address - State:NH
Mailing Address - Zip Code:03253-0334
Mailing Address - Country:US
Mailing Address - Phone:603-279-8169
Mailing Address - Fax:603-279-8169
Practice Address - Street 1:248 DANIEL WEBSTER HWY
Practice Address - Street 2:
Practice Address - City:MEREDITH
Practice Address - State:NH
Practice Address - Zip Code:03253-5803
Practice Address - Country:US
Practice Address - Phone:603-279-8169
Practice Address - Fax:603-279-8169
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-05-31
Last Update Date:2016-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH144101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH30008824Medicaid