Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103TS0200X | School Psychologist | 66539 | NH |
NPI | 1063095545 |
---|---|
Provider Name | Dr. John Secor III |
First Address | Newmarket, NH 03857-1518 |
Second Address | Newmarket, NH 03857-1518 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/05/2021 |
Last Update Date | 03/05/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
66539 | (05) | NH |