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General NPI Number Information
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NPI Number | 1952453060
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Entity Type | Individual
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Provider Name | AUTUMN DAMARA PRIOR LICSW
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Gender | Female
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Dates
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Enumeration Date | 01/17/2007
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Last Update Date | 11/03/2016
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Provider Practice Location Address
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Address Line | 106 SPRING ST SUITE #210
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City | NEW BEDFORD
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State | MA
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Zip | 02740-5951
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Country | US
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Telephone | 508-837-9587
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Fax | 508-300-8808
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Provider Business Mailing Address
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Address Line | 5500 N MAIN ST BLDG 15 APT 109
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City | FALL RIVER
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State | MA
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Zip | 02720-2061
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Country | US
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Telephone | 401-862-2717
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 214413
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License Number State | MA
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Taxonomy #2
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 114310
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License Number State | MA
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