1265207872 NPI number — MS. HEATHER PHYLLIS ARCHAMBAULT MSW

Table of content: MS. HEATHER PHYLLIS ARCHAMBAULT MSW (NPI 1265207872)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1265207872 NPI number — MS. HEATHER PHYLLIS ARCHAMBAULT MSW

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ARCHAMBAULT
Provider First Name:
HEATHER
Provider Middle Name:
PHYLLIS
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
MSW
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1265207872
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/12/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
195 MCGREGOR STREET
Provider Second Line Business Mailing Address:
UNIT 400
Provider Business Mailing Address City Name:
MANCHESTER
Provider Business Mailing Address State Name:
NH
Provider Business Mailing Address Postal Code:
03102
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
603-206-2700
Provider Business Mailing Address Fax Number:
603-668-5443

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
195 MCGREGOR STREET
Provider Second Line Business Practice Location Address:
UNIT 400
Provider Business Practice Location Address City Name:
MANCHESTER
Provider Business Practice Location Address State Name:
NH
Provider Business Practice Location Address Postal Code:
03102
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
603-206-2700
Provider Business Practice Location Address Fax Number:
603-668-5443
Provider Enumeration Date:
11/24/2023

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 1041C0700X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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