Provider Demographics
NPI:1508133125
Name:MONADNOCK FAMILY SERVICES
Entity Type:Organization
Organization Name:MONADNOCK FAMILY SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHEIF MEDICAL OFFICER
Authorized Official - Prefix:DR
Authorized Official - First Name:FREDERICK
Authorized Official - Middle Name:A
Authorized Official - Last Name:AGISIM
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:603-357-5270
Mailing Address - Street 1:17 93RD ST
Mailing Address - Street 2:
Mailing Address - City:KEENE
Mailing Address - State:NH
Mailing Address - Zip Code:03431-3989
Mailing Address - Country:US
Mailing Address - Phone:603-357-5270
Mailing Address - Fax:603-357-6896
Practice Address - Street 1:17 93RD ST
Practice Address - Street 2:
Practice Address - City:KEENE
Practice Address - State:NH
Practice Address - Zip Code:03431-3989
Practice Address - Country:US
Practice Address - Phone:603-357-5270
Practice Address - Fax:603-357-6896
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-11-28
Last Update Date:2011-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH057994-21261QM0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)