Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 102L00000X | Psychologist | 932 | NH |
Y | 103T00000X | Psychologist | 932 | NH |
N | 103TA0400X | Addiction Psychologist (Substance Use Disorder) | 932 | NH |
NPI | 1164805891 |
---|---|
Provider Name | Dr. Mark P. Mcgovern |
First Address | Lebanon, NH 03766-1537 |
Second Address | Lebanon, NH 03766-1537 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 30/06/2015 |
Last Update Date | 30/06/2015 |