Licensed Support Corp

Primary specialty

Community/Behavioral Health AgencyTaxonomy code 251S00000X

Legal business name

LICENSED SUPPORT CORP

Practice address

283 Scenic Drive
Manchester, NH 03103

Phone

(845) 596-2271

NPI assigned

May 10, 2023

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Yocheved Wasserman

Title

President

Phone

(845) 596-2271

Specialties & licenses 1

Addresses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1683676800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1683676800000",
    "number": "1336839711",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "283 SCENIC DRIVE",
            "city": "MANCHESTER",
            "state": "NH",
            "postal_code": "03103"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "283 SCENIC DRIVE",
            "city": "MANCHESTER",
            "state": "NH",
            "postal_code": "03103",
            "telephone_number": "845-596-2271"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LICENSED SUPPORT CORP",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-05-10",
        "last_updated": "2023-05-10",
        "certification_date": "2023-04-27",
        "status": "A",
        "authorized_official_last_name": "WASSERMAN",
        "authorized_official_first_name": "YOCHEVED",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "845-596-2271"
    },
    "taxonomies": [
        {
            "code": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Kathryne Libbra, BCBA
• Douglas L Libby, PHARM.D.
• Kristen Es Libby, LICSW
• Shannon Kristina Libby, MSW
• Kimberly Ann Licciardi, MD
• Carol Liddell, RNC, MS
• Gabriele Lieberg, MD
• Joseph John Lienert, M.D.
• Lifeshare Management Group, Inc.
• Lifeshare Midwest, LLC

• Community/Behavioral Health Agency in Manchester, NH
• Providers in Manchester, NH by specialty
• Community/Behavioral Health Agency in New Hampshire

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 10, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.