Healthcare Provider Details

I. General information

NPI: 1124087473
Provider Name (Legal Business Name): LAURELLEN FOSTER LICSW
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 03/23/2006
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

445 CYPRESS STREET, MANCHESTER COUNSELING SERVICES SUITE 8
MANCHESTER NH
03103
US

IV. Provider business mailing address

445 CYPRESS STREET MANCHESTER COUNSELING SERVICES, SUITE 8
MANCHESTER NH
03103
US

V. Phone/Fax

Practice location:
  • Phone: 603-668-4079
  • Fax: 603-663-8605
Mailing address:
  • Phone: 603-668-4079
  • Fax: 603-663-8605

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number1222
License Number StateNH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: