Provider Demographics
NPI:1861077828
Name:SEYMOUR, KRISTEN L (MA, CAGS)
Entity type:Individual
Prefix:
First Name:KRISTEN
Middle Name:L
Last Name:SEYMOUR
Suffix:
Gender:F
Credentials:MA, CAGS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:53 OLD SANDOWN RD
Mailing Address - Street 2:
Mailing Address - City:CHESTER
Mailing Address - State:NH
Mailing Address - Zip Code:03036-4124
Mailing Address - Country:US
Mailing Address - Phone:603-244-0121
Mailing Address - Fax:
Practice Address - Street 1:295 MAIN ST
Practice Address - Street 2:
Practice Address - City:SANDOWN
Practice Address - State:NH
Practice Address - Zip Code:03873-2647
Practice Address - Country:US
Practice Address - Phone:603-887-3648
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-03-11
Last Update Date:2021-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH100372103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH3075434Medicaid