| Green House Group Pa | |
|
250 Commercial Street Suite 3004 Manchester NH 03101-1118 | |
| (603) 668-3050 | |
| (603) 668-8666 |
| Full Name | Green House Group Pa |
|---|---|
| Speciality | Psychologist |
| Location | 250 Commercial Street, Manchester, New Hampshire |
| Authorized Official Name and Position | Melissa Wallace (VICE PRESIDENT) |
| Authorized Official Contact | 6036683050 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Green House Group Pa 250 Commercial Street Suite 3004 Manchester NH 03101 Ph: (603) 668-3050 | Green House Group Pa 250 Commercial Street Suite 3004 Manchester NH 03101-1118 Ph: (603) 668-3050 |
| NPI Number | 1326256611 |
|---|---|
| Provider Enumeration Date | 05/18/2007 |
| Last Update Date | 07/10/2023 |
| Certification Date | 07/10/2023 |
| Medicare PECOS PAC ID | 1153370549 |
|---|---|
| Medicare Enrollment ID | O20050112000668 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1326256611 | NPI | - | NPPES |
| 3076407 | Medicaid | NH | |
| 3076408 | Medicaid | NH |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 103T00000X | Psychologist | 512 (New Hampshire) | Primary |
| Provider Name | James B Halla |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1417050972 PECOS PAC ID: 9638187255 Enrollment ID: I20060323000427 |
| Provider Name | Douglas B Johnson |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1801812839 PECOS PAC ID: 2769511781 Enrollment ID: I20120316000610 |
| Provider Name | Ann L Rosoff |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1477583979 PECOS PAC ID: 9537393426 Enrollment ID: I20131008001510 |
| Provider Name | Zachary Delcambre |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1972889541 PECOS PAC ID: 7416212402 Enrollment ID: I20180522001108 |
| Provider Name | Debra Hansen |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1538633599 PECOS PAC ID: 6800136144 Enrollment ID: I20190322000845 |
| Provider Name | Melissa M Wallace |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1235216482 PECOS PAC ID: 4183993454 Enrollment ID: I20210223003162 |
| Provider Name | Jeremy Freund |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1588621122 PECOS PAC ID: 5991722555 Enrollment ID: I20210712003383 |
| Provider Name | Lucia Allosso |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1083373310 PECOS PAC ID: 6709253628 Enrollment ID: I20221107002282 |
| Provider Name | Carol L Gay |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1831617125 PECOS PAC ID: 6204274152 Enrollment ID: I20240410003722 |
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