Basic Information
| Provider Information | |||||||||
| NPI: | 1982672598 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | THORINGTON | ||||||||
| FirstName: | PAUL | ||||||||
| MiddleName: | K | ||||||||
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| Credential: | EDD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 33 WARREN ST | ||||||||
| Address2: | |||||||||
| City: | CONCORD | ||||||||
| State: | NH | ||||||||
| PostalCode: | 03301 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6032261999 | ||||||||
| FaxNumber: | 6032241675 | ||||||||
| Practice Location | |||||||||
| Address1: | 33 WARREN ST | ||||||||
| Address2: | |||||||||
| City: | CONCORD | ||||||||
| State: | NH | ||||||||
| PostalCode: | 03301 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6032261999 | ||||||||
| FaxNumber: | 6032241675 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/09/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | X | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 103TC0700X | 498 | NH | Y | Behavioral Health & Social Service Providers | Psychologist | Clinical |
ID Information
| ID | Type | State | Issuer | Description | 30004121 | 05 | NH | MEDICAID |