Provider Demographics
NPI:1609286665
Name:MARY BETH BLOSER, LICSW
Entity type:Organization
Organization Name:MARY BETH BLOSER, LICSW
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:MARY
Authorized Official - Middle Name:BETH
Authorized Official - Last Name:BLOSER
Authorized Official - Suffix:
Authorized Official - Credentials:LICSW
Authorized Official - Phone:603-828-3216
Mailing Address - Street 1:20 LADD ST STE 400
Mailing Address - Street 2:
Mailing Address - City:PORTSMOUTH
Mailing Address - State:NH
Mailing Address - Zip Code:03801-4089
Mailing Address - Country:US
Mailing Address - Phone:603-828-3216
Mailing Address - Fax:
Practice Address - Street 1:20 LADD ST STE 400
Practice Address - Street 2:
Practice Address - City:PORTSMOUTH
Practice Address - State:NH
Practice Address - Zip Code:03801-4089
Practice Address - Country:US
Practice Address - Phone:603-828-3216
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-04-30
Last Update Date:2014-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH8631041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NHRE5183Medicare UPIN