Provider Demographics
NPI:1952591331
Name:CHILD HEALTH SERVICS (TEEN HEALTH CLINIC)
Entity type:Organization
Organization Name:CHILD HEALTH SERVICS (TEEN HEALTH CLINIC)
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:LISA
Authorized Official - Middle Name:A
Authorized Official - Last Name:DIBRIGIDA, MD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:603-668-6629
Mailing Address - Street 1:1245 ELM STREET
Mailing Address - Street 2:
Mailing Address - City:MANCHESTER
Mailing Address - State:NH
Mailing Address - Zip Code:03101
Mailing Address - Country:US
Mailing Address - Phone:603-668-6629
Mailing Address - Fax:603-622-7680
Practice Address - Street 1:1245 ELM STREET
Practice Address - Street 2:
Practice Address - City:MANCHESTER
Practice Address - State:NH
Practice Address - Zip Code:03101
Practice Address - Country:US
Practice Address - Phone:603-629-9707
Practice Address - Fax:603-629-9694
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CHILD HEALTH SERVICES
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-07-31
Last Update Date:2014-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care