Healthcare Provider Details

I. General information

NPI: 1235336017
Provider Name (Legal Business Name): MARJORIE ANN HUDGENS MSW, LICSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/27/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20 W PARK ST COUNSELING CENTER OF LEBANON
LEBANON NH
03766-1378
US

IV. Provider business mailing address

90 HINKSON BROOK RD
CANAAN NH
03741-7458
US

V. Phone/Fax

Practice location:
  • Phone: 603-448-1101
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number1366
License Number StateNH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: