Doctor Name: | MARY G COVENTRY |
NPI Number: | 1053792929 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | |
License Number: | |
Business Practice Address: | 17 93rd St Keene, NH - 034313989 |
Business Phone Number: | 6032831570 |
Business Fax Number: | 6033579648 |
Mailing Address: | 64 Main St, KEENE |
State: | NH |
Postal Code: | 034313701 |
Phone Number: | 6032831570 |
Fax Number: | 6033579648 |
NPI Enumeration Date: | 06/16/2015 |
NPI Last Update Date: | 06/16/2015 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 101YM0800X |
License Number: | |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Counselor |
Taxonomy Specialization: | Mental Health |
Taxonomy Definition: |