Provider Demographics
NPI:1780754093
Name:WARREN STREET FAMILY COUNSELING ASSOC INC
Entity type:Organization
Organization Name:WARREN STREET FAMILY COUNSELING ASSOC INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:C ANN
Authorized Official - Middle Name:
Authorized Official - Last Name:FREESE
Authorized Official - Suffix:
Authorized Official - Credentials:MA LMHC
Authorized Official - Phone:603-226-1999
Mailing Address - Street 1:33 WARREN ST
Mailing Address - Street 2:
Mailing Address - City:CONCORD
Mailing Address - State:NH
Mailing Address - Zip Code:03301
Mailing Address - Country:US
Mailing Address - Phone:603-226-1999
Mailing Address - Fax:603-224-1675
Practice Address - Street 1:33 WARREN ST
Practice Address - Street 2:
Practice Address - City:CONCORD
Practice Address - State:NH
Practice Address - Zip Code:03301
Practice Address - Country:US
Practice Address - Phone:603-226-1999
Practice Address - Fax:603-224-1675
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-08
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
326417OtherMHN TRICARE
NHRE7205Medicare ID - Type Unspecified