Healthcare Provider Details

I. General information

NPI: 1275147928
Provider Name (Legal Business Name): LAURYN SPADAFORE M.ED.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/01/2020
Last Update Date: 09/01/2020
Certification Date: 09/01/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14 CHURCH ST
WARNER NH
03278-4527
US

IV. Provider business mailing address

43 LOVERIN HILL RD
SALISBURY NH
03268-5111
US

V. Phone/Fax

Practice location:
  • Phone: 603-456-2241
  • Fax:
Mailing address:
  • Phone: 603-229-7005
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TS0200X
TaxonomySchool Psychologist
License Number113772
License Number StateNH

VII. Legacy identifiers

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: