Healthcare Provider Details

I. General information

NPI: 1114418340
Provider Name (Legal Business Name): MADELINE PLUMMER LICSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/23/2018
Last Update Date: 08/17/2026
Certification Date: 08/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

25 BAYBERRY DR
ATKINSON NH
03811-2719
US

IV. Provider business mailing address

25 BAYBERRY DR
ATKINSON NH
03811-2719
US

V. Phone/Fax

Practice location:
  • Phone: 978-218-8428
  • Fax:
Mailing address:
  • Phone: 920-209-0963
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number123420
License Number StateMA
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number5993
License Number StateNH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: