1619030459 NPI number — MARILYN A LAURIA LICSW

Table of content: MARILYN A LAURIA LICSW (NPI 1619030459)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1619030459 NPI number — MARILYN A LAURIA LICSW

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
LAURIA
Provider First Name:
MARILYN
Provider Middle Name:
A
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
LICSW
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1619030459
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
9 HANOVER ST
Provider Second Line Business Mailing Address:
SUITE 2 WEST CENTRAL SERVICES INC
Provider Business Mailing Address City Name:
LEBANON
Provider Business Mailing Address State Name:
NH
Provider Business Mailing Address Postal Code:
03766
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
603-448-0126
Provider Business Mailing Address Fax Number:
603-448-6001

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
20 WEST PARK ST
Provider Second Line Business Practice Location Address:
SUITES 416 & 219
Provider Business Practice Location Address City Name:
LEBANON
Provider Business Practice Location Address State Name:
NH
Provider Business Practice Location Address Postal Code:
03766
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
603-448-1101
Provider Business Practice Location Address Fax Number:
603-448-8240
Provider Enumeration Date:
12/19/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 1041C0700X , with the licence number:  998 , registered in the state of NH ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)