Organization
LIFESTAGES FAMILY NEUROHEALTH LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JAMIE L TIMMINS (CREDENTIALING COORDINATOR)
(603) 233-9801
Entity
Organization
Contact information
Practice address
40 S RIVER RD UNIT 33, BEDFORD, NH 03110-6721
(603) 614-6016
Mailing address
40 S RIVER RD UNIT 33, BEDFORD, NH 03110-6721
(603) 614-6016
Taxonomy
Speciality
Code
Description
License number
State
103G00000X
Clinical Neuropsychologist
Primary
—
—
103TC0700X
Clinical Psychologist
—
—
Other
Enumeration date
03/06/2020
Last updated
03/06/2020
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