Provider Demographics
NPI:1366927410
Name:KOUMANTZELIS, GIA (LICSW)
Entity type:Individual
Prefix:
First Name:GIA
Middle Name:
Last Name:KOUMANTZELIS
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 118
Mailing Address - Street 2:
Mailing Address - City:BETHLEHEM
Mailing Address - State:NH
Mailing Address - Zip Code:03574-0118
Mailing Address - Country:US
Mailing Address - Phone:603-869-3978
Mailing Address - Fax:
Practice Address - Street 1:240 VALLEY VIEW LANE
Practice Address - Street 2:
Practice Address - City:BETHLEHEM
Practice Address - State:NH
Practice Address - Zip Code:03574
Practice Address - Country:US
Practice Address - Phone:978-518-9809
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-09-25
Last Update Date:2018-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical