Provider Demographics
NPI:1356765523
Name:BUILDING BLOCKS CHILD AND ADULT PSYCHOTHERAPY, LLC
Entity type:Organization
Organization Name:BUILDING BLOCKS CHILD AND ADULT PSYCHOTHERAPY, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:ROSS
Authorized Official - Middle Name:WHITNEY
Authorized Official - Last Name:DAVIDSON
Authorized Official - Suffix:
Authorized Official - Credentials:LCMHC
Authorized Official - Phone:603-831-6392
Mailing Address - Street 1:20 GROVE ST
Mailing Address - Street 2:SUITE 200
Mailing Address - City:PETERBOROUGH
Mailing Address - State:NH
Mailing Address - Zip Code:03458-1470
Mailing Address - Country:US
Mailing Address - Phone:603-831-6392
Mailing Address - Fax:603-924-4215
Practice Address - Street 1:20 GROVE ST
Practice Address - Street 2:SUITE 200
Practice Address - City:PETERBOROUGH
Practice Address - State:NH
Practice Address - Zip Code:03458-1470
Practice Address - Country:US
Practice Address - Phone:603-831-6392
Practice Address - Fax:603-924-4215
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-02-09
Last Update Date:2014-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH985251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH3092409OtherMEDICAID GROUP ID #
NH3089977Medicaid