Provider Demographics
NPI:1245712322
Name:NEILSON, NATALIE ALISE (BA)
Entity type:Individual
Prefix:
First Name:NATALIE
Middle Name:ALISE
Last Name:NEILSON
Suffix:
Gender:F
Credentials:BA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:372 WEST ST STE 102
Mailing Address - Street 2:
Mailing Address - City:KEENE
Mailing Address - State:NH
Mailing Address - Zip Code:03431-2412
Mailing Address - Country:US
Mailing Address - Phone:603-338-0033
Mailing Address - Fax:
Practice Address - Street 1:372 WEST ST STE 102
Practice Address - Street 2:
Practice Address - City:KEENE
Practice Address - State:NH
Practice Address - Zip Code:03431-2412
Practice Address - Country:US
Practice Address - Phone:603-338-0033
Practice Address - Fax:603-719-1266
Is Sole Proprietor?:No
Enumeration Date:2018-09-05
Last Update Date:2024-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
1041C0700X
NH1533101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical