Provider Demographics
NPI:1669780441
Name:VANDEN BOSCH, SUE ANN (LCMHC)
Entity type:Individual
Prefix:
First Name:SUE
Middle Name:ANN
Last Name:VANDEN BOSCH
Suffix:
Gender:F
Credentials:LCMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1145 SAGAMORE AVE
Mailing Address - Street 2:
Mailing Address - City:PORTSMOUTH
Mailing Address - State:NH
Mailing Address - Zip Code:03801-5503
Mailing Address - Country:US
Mailing Address - Phone:603-431-6703
Mailing Address - Fax:603-430-3753
Practice Address - Street 1:106 ROXBURY ST
Practice Address - Street 2:
Practice Address - City:KEENE
Practice Address - State:NH
Practice Address - Zip Code:03431-3816
Practice Address - Country:US
Practice Address - Phone:603-358-4041
Practice Address - Fax:603-358-6527
Is Sole Proprietor?:No
Enumeration Date:2010-09-15
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH752101YM0800X, 101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH3078870Medicaid