Provider Demographics
NPI:1912079443
Name:CENTRAL PSYCHOLOGY SERVICES LLC
Entity Type:Organization
Organization Name:CENTRAL PSYCHOLOGY SERVICES LLC
Other - Org Name:LIMITED LIABILITY CORPORATION
Other - Org Type:Other Name
Authorized Official - Title/Position:PSYCHOLOGIST MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:ELIZABETH
Authorized Official - Middle Name:
Authorized Official - Last Name:LACHAPELLE
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:603-536-5223
Mailing Address - Street 1:PO BOX 42
Mailing Address - Street 2:
Mailing Address - City:PLYMOUTH
Mailing Address - State:NH
Mailing Address - Zip Code:03264
Mailing Address - Country:US
Mailing Address - Phone:603-536-5223
Mailing Address - Fax:603-536-5223
Practice Address - Street 1:5 SOUTH MAIN STREET
Practice Address - Street 2:
Practice Address - City:PLYMOUTH
Practice Address - State:NH
Practice Address - Zip Code:03264
Practice Address - Country:US
Practice Address - Phone:603-536-5223
Practice Address - Fax:603-536-5223
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-13
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH891103TC0700X
MA4999103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH30421468Medicaid
NH30421468Medicaid