Healthcare Provider Details

I. General information

NPI: 1124114376
Provider Name (Legal Business Name): LOUISE RADER LICSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/05/2006
Last Update Date: 11/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

64 MAIN ST SUITE 201
KEENE NH
03431-3701
US

IV. Provider business mailing address

17 93RD ST
KEENE NH
03431-3748
US

V. Phone/Fax

Practice location:
  • Phone: 603-283-1546
  • Fax: 603-355-3833
Mailing address:
  • Phone: 603-283-1546
  • Fax: 603-355-3833

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number909
License Number StateNH

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier81263595
Identifier TypeMEDICAID
Identifier StateNH
Identifier Issuer

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: