Healthcare Provider Details

I. General information

NPI: 1609099506
Provider Name (Legal Business Name): STACY A CARPENTER LICSW, MLADC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: STACY A LACORCIA CTRS

II. Dates (important events)

Enumeration Date: 04/10/2007
Last Update Date: 08/05/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

323 GONIC ROAD SUITE 5
ROCHESTER NH
03839-4592
US

IV. Provider business mailing address

55 SHERBORNE ROAD
BARRINGTON NH
03825-5519
US

V. Phone/Fax

Practice location:
  • Phone: 603-332-8000
  • Fax:
Mailing address:
  • Phone: 603-571-4317
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number0988
License Number StateNH
# 2
Primary TaxonomyN
Taxonomy Code225800000X
TaxonomyRecreation Therapist
License Number39488
License Number StateNH
# 3
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number2247
License Number StateNH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: