Provider Demographics
NPI:1861762437
Name:AUSTIN, THEODORE M (PSYD)
Entity type:Individual
Prefix:DR
First Name:THEODORE
Middle Name:M
Last Name:AUSTIN
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 527
Mailing Address - Street 2:
Mailing Address - City:CONTOOCOOK
Mailing Address - State:NH
Mailing Address - Zip Code:03229-0527
Mailing Address - Country:US
Mailing Address - Phone:603-313-1045
Mailing Address - Fax:603-603-4563
Practice Address - Street 1:51 E MAIN ST
Practice Address - Street 2:
Practice Address - City:WARNER
Practice Address - State:NH
Practice Address - Zip Code:03278-4408
Practice Address - Country:US
Practice Address - Phone:603-313-1045
Practice Address - Fax:603-456-3383
Is Sole Proprietor?:Yes
Enumeration Date:2012-01-12
Last Update Date:2018-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH1288103TC0700X, 103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103T00000XBehavioral Health & Social Service ProvidersPsychologist