Provider Demographics
NPI:1124911342
Name:ARDIZZONE, VINCENT GEORGE (MA, LCMHC)
Entity type:Individual
Prefix:MR
First Name:VINCENT
Middle Name:GEORGE
Last Name:ARDIZZONE
Suffix:
Gender:M
Credentials:MA, LCMHC
Other - Prefix:MR
Other - First Name:VINCENT
Other - Middle Name:GEORGE
Other - Last Name:ARDIZZONE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MA, LCMHC
Mailing Address - Street 1:66 PROSPECT ST
Mailing Address - Street 2:
Mailing Address - City:MANCHESTER
Mailing Address - State:NH
Mailing Address - Zip Code:03104-3506
Mailing Address - Country:US
Mailing Address - Phone:603-270-9217
Mailing Address - Fax:603-270-9217
Practice Address - Street 1:66 PROSPECT ST
Practice Address - Street 2:
Practice Address - City:MANCHESTER
Practice Address - State:NH
Practice Address - Zip Code:03104-3506
Practice Address - Country:US
Practice Address - Phone:603-270-9217
Practice Address - Fax:603-270-9217
Is Sole Proprietor?:No
Enumeration Date:2025-05-29
Last Update Date:2025-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH5212101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health