Healthcare Provider Details

I. General information

NPI: 1093836009
Provider Name (Legal Business Name): DR. LAURIE BRODEUR
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/03/2007
Last Update Date: 09/30/2026
Certification Date: 09/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3 12TH ST
BERLIN NH
03570-3860
US

IV. Provider business mailing address

626 EASTMAN RD STE A
CENTER CONWAY NH
03813-4219
US

V. Phone/Fax

Practice location:
  • Phone: 603-752-7404
  • Fax: 603-752-5194
Mailing address:
  • Phone: 603-447-3347
  • Fax: 603-447-8893

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number604
License Number StateNH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: