Provider Demographics
NPI:1336861392
Name:FAUTH, DANA LUCILLE (MED/EDS)
Entity Type:Individual
Prefix:
First Name:DANA
Middle Name:LUCILLE
Last Name:FAUTH
Suffix:
Gender:F
Credentials:MED/EDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:141 LEDGE ST
Mailing Address - Street 2:
Mailing Address - City:NASHUA
Mailing Address - State:NH
Mailing Address - Zip Code:03060-3073
Mailing Address - Country:US
Mailing Address - Phone:603-966-1000
Mailing Address - Fax:
Practice Address - Street 1:141 LEDGE ST
Practice Address - Street 2:
Practice Address - City:NASHUA
Practice Address - State:NH
Practice Address - Zip Code:03060-3073
Practice Address - Country:US
Practice Address - Phone:603-966-1000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-09-16
Last Update Date:2022-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH142656103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool