Provider Demographics
NPI:1336532670
Name:CONSTABLE, MATTHEW R (LCMHC)
Entity Type:Individual
Prefix:
First Name:MATTHEW
Middle Name:R
Last Name:CONSTABLE
Suffix:
Gender:M
Credentials:LCMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1087 ELM ST
Mailing Address - Street 2:SUITE 204
Mailing Address - City:MANCHESTER
Mailing Address - State:NH
Mailing Address - Zip Code:03101-1853
Mailing Address - Country:US
Mailing Address - Phone:603-440-8175
Mailing Address - Fax:
Practice Address - Street 1:1087 ELM ST
Practice Address - Street 2:SUITE 404
Practice Address - City:MANCHESTER
Practice Address - State:NH
Practice Address - Zip Code:03101-1853
Practice Address - Country:US
Practice Address - Phone:603-851-1480
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-03-11
Last Update Date:2021-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH1088101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health