Provider Demographics
NPI:1700956257
Name:BACHELLER LONDON, GAIL MARIE (LICSW)
Entity Type:Individual
Prefix:MRS
First Name:GAIL
Middle Name:MARIE
Last Name:BACHELLER LONDON
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:104 FAITH DR
Mailing Address - Street 2:
Mailing Address - City:HAMPSTEAD
Mailing Address - State:NH
Mailing Address - Zip Code:03841-2397
Mailing Address - Country:US
Mailing Address - Phone:603-329-7445
Mailing Address - Fax:
Practice Address - Street 1:20 MARY E CLARK DR
Practice Address - Street 2:RAYMOND BLDG. SUITE 6A
Practice Address - City:HAMPSTEAD
Practice Address - State:NH
Practice Address - Zip Code:03841-2292
Practice Address - Country:US
Practice Address - Phone:603-329-6784
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH11681041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH14Y008224NH01OtherANTHEM PROVIDER IDENTIFIC
NH30423690Medicaid