Provider Demographics
NPI:1912619685
Name:ANDOVER THERAPY SERVICES LLC
Entity Type:Organization
Organization Name:ANDOVER THERAPY SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICENSED MENTAL HEALTH COUNSELOR
Authorized Official - Prefix:
Authorized Official - First Name:KATELYN
Authorized Official - Middle Name:KELEIGH
Authorized Official - Last Name:MACDONALD
Authorized Official - Suffix:
Authorized Official - Credentials:LMHC
Authorized Official - Phone:603-843-5108
Mailing Address - Street 1:68 CARMEL RD
Mailing Address - Street 2:
Mailing Address - City:ANDOVER
Mailing Address - State:MA
Mailing Address - Zip Code:01810-3118
Mailing Address - Country:US
Mailing Address - Phone:603-843-5108
Mailing Address - Fax:
Practice Address - Street 1:38 MAIN ST STE 2B
Practice Address - Street 2:
Practice Address - City:ANDOVER
Practice Address - State:MA
Practice Address - Zip Code:01810-3733
Practice Address - Country:US
Practice Address - Phone:603-843-5108
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-12-14
Last Update Date:2022-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty