=====================================================
General NPI Number Information
=====================================================
NPI Number | 1053828301
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | WOMENS COUNSELING OF NASHUA PLLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/09/2018
-----------------------------------------------------
Last Update Date | 01/09/2018
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 71 SPIT BROOK RD STE 403
-----------------------------------------------------
City | NASHUA
-----------------------------------------------------
State | NH
-----------------------------------------------------
Zip | 03060-5636
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 603-566-0942
-----------------------------------------------------
Fax | 603-554-8617
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 71 SPIT BROOK RD STE 403
-----------------------------------------------------
City | NASHUA
-----------------------------------------------------
State | NH
-----------------------------------------------------
Zip | 03060-5636
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 603-566-0942
-----------------------------------------------------
Fax | 603-554-8617
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | LICENSED CLINICAL SOCIAL WORKER
-----------------------------------------------------
Name | LAURA DUNCAN
-----------------------------------------------------
Credential | MSW, LICSW
-----------------------------------------------------
Telephone | 603-566-0942
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1041C0700X
-----------------------------------------------------
Taxonomy Name | Clinical Social Worker
-----------------------------------------------------
License Number | 1585
-----------------------------------------------------
License Number State | NH
-----------------------------------------------------