Provider Demographics
NPI:1447345814
Name:PAIGE, ANTHONY JAMES (MA, LSW, VSO, GCDF)
Entity type:Individual
Prefix:MR
First Name:ANTHONY
Middle Name:JAMES
Last Name:PAIGE
Suffix:
Gender:M
Credentials:MA, LSW, VSO, GCDF
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17 93RD STREET
Mailing Address - Street 2:
Mailing Address - City:KEENE
Mailing Address - State:NH
Mailing Address - Zip Code:03431
Mailing Address - Country:US
Mailing Address - Phone:603-283-1643
Mailing Address - Fax:603-357-3292
Practice Address - Street 1:17 93RD STREET
Practice Address - Street 2:
Practice Address - City:KEENE
Practice Address - State:NH
Practice Address - Zip Code:03431
Practice Address - Country:US
Practice Address - Phone:603-283-1643
Practice Address - Fax:603-357-3292
Is Sole Proprietor?:No
Enumeration Date:2006-10-03
Last Update Date:2007-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
00617101YP2500X
MA3131291041C0700X
2884PAIGE171000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No171000000XOther Service ProvidersMilitary Health Care Provider