Provider Demographics
NPI:1902007677
Name:NEURODEVELOPMENTAL INSTITUTE OF NEW HAMPSHIRE, LLC
Entity Type:Organization
Organization Name:NEURODEVELOPMENTAL INSTITUTE OF NEW HAMPSHIRE, LLC
Other - Org Name:MONT BLANC ACADEMY INC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:E
Authorized Official - Last Name:MCLAUGHLIN-BELTZ
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:603-621-9870
Mailing Address - Street 1:171 LONDONDERRY TURNPIKE
Mailing Address - Street 2:
Mailing Address - City:HOOKSETT
Mailing Address - State:NH
Mailing Address - Zip Code:03106
Mailing Address - Country:US
Mailing Address - Phone:603-621-9870
Mailing Address - Fax:603-621-9875
Practice Address - Street 1:171 LONDONDERRY TURNPIKE
Practice Address - Street 2:
Practice Address - City:HOOKSETT
Practice Address - State:NH
Practice Address - Zip Code:03106
Practice Address - Country:US
Practice Address - Phone:603-621-9870
Practice Address - Fax:603-621-9875
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-30
Last Update Date:2021-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH994103G00000X, 103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103G00000XBehavioral Health & Social Service ProvidersClinical NeuropsychologistGroup - Multi-Specialty
No103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH11662811OtherCIGNA
NH30422737Medicaid
NH06Y008256NH01OtherANTHEM