Individual ProviderTimothy WightCounselorBehavioral Health & Social Service ProvidersPractice Address360 Route 101 Ste 13b, Bedford, NH 03110-5033(603) 488-1773(617) 771-6582PECOS EnrollmentBased on the most recent information from CMS, provider Timothy Wight is legally eligible to order and refer claims for Part B and DME services only.Part BMedicare Part BEnrolledHHAHome Health AgencyNot EnrolledDMEDurable Medical EquipmentEnrolledPMDPower Mobility DeviceNot EnrolledCMS last updated its PECOS records 2 days ago.Profile DetailsProvider ID1487102224Provider TypeIndividualFull NameWight, TimothyCredentialLICSWGenderMaleSole ProprietorNoEnumeration Date9/21/2016Last Updated9/24/2022Contact InformationPractice LocationPractice Address360 Route 101 Ste 13b, Bedford, NH 03110-5033Phone(603) 488-1773Fax(844) 907-2936Mailing LocationMailing Address43 Granite St, Melrose, MA 02176-5801Phone(617) 771-6582FaxUnlisted FaxProvider TaxonomiesCodeDescriptionLicenseCode101YM0800XPrimaryDescriptionCounselorBehavioral Health & Social Service ProvidersLicenseUnlisted IssuerProvider IdentifiersIDDescriptionIssuerID3136239DescriptionMedicaidIssuerUnlistedNew Hampshire