Individual
DR. JOEL NATHAN GLENN WIXSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PSYD CAS
Contact information
Practice address
539 ISLINGTON ST, 5, PORTSMOUTH, NH 03801
(603) 427-6858
(603) 427-6555
Mailing address
539 ISLINGTON ST, 5, PORTSMOUTH, NH 03801
(603) 427-6858
(603) 427-6555
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
1056
NH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
06Y00744INH01
ANTHEM BCBS
NH
05
—
304ZO374
—
NH
Enumeration date
11/16/2006
Last updated
07/08/2007
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