Healthcare Provider Details

I. General information

NPI: 1922828698
Provider Name (Legal Business Name): EMMA DEGRASSE LICSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/16/2024
Last Update Date: 10/16/2024
Certification Date: 10/16/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

85 MECHANIC ST
LEBANON NH
03766-1537
US

IV. Provider business mailing address

85 MECHANIC ST
LEBANON NH
03766-1537
US

V. Phone/Fax

Practice location:
  • Phone: 603-448-1101
  • Fax: 603-448-0129
Mailing address:
  • Phone: 603-448-1101
  • Fax: 603-448-0129

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number5118
License Number StateNH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: