Provider Demographics
NPI:1124136270
Name:STRONG, MARYANNE C (LICSW, LADC)
Entity type:Individual
Prefix:MS
First Name:MARYANNE
Middle Name:C
Last Name:STRONG
Suffix:
Gender:F
Credentials:LICSW, LADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:317 PARK AVE
Mailing Address - Street 2:
Mailing Address - City:KEENE
Mailing Address - State:NH
Mailing Address - Zip Code:03431-1555
Mailing Address - Country:US
Mailing Address - Phone:603-358-6789
Mailing Address - Fax:603-358-6789
Practice Address - Street 1:317 PARK AVE
Practice Address - Street 2:
Practice Address - City:KEENE
Practice Address - State:NH
Practice Address - Zip Code:03431-1555
Practice Address - Country:US
Practice Address - Phone:603-358-6789
Practice Address - Fax:603-358-6789
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-28
Last Update Date:2015-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH558101YA0400X
VT103904101YA0400X
VT08900009821041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH30Y007518NH01OtherBCBS BHN
NH2192725OtherCIGNA BHN