Healthcare Provider Details

I. General information

NPI: 1154813145
Provider Name (Legal Business Name): HEATHER WADE LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/05/2018
Last Update Date: 07/13/2026
Certification Date: 07/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

30 MAGNOLIA LN
EXETER NH
03833-2526
US

IV. Provider business mailing address

30 MAGNOLIA LN
EXETER NH
03833-2526
US

V. Phone/Fax

Practice location:
  • Phone: 603-957-5979
  • Fax:
Mailing address:
  • Phone: 603-957-5979
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number5152
License Number StateNH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: