Provider Demographics
NPI:1285978031
Name:LARUE, KRISTEN A (LICSW)
Entity type:Individual
Prefix:MRS
First Name:KRISTEN
Middle Name:A
Last Name:LARUE
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:KRISTEN
Other - Middle Name:A
Other - Last Name:LUCIER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 392
Mailing Address - Street 2:
Mailing Address - City:ASHLAND
Mailing Address - State:NH
Mailing Address - Zip Code:03217-0392
Mailing Address - Country:US
Mailing Address - Phone:978-504-1435
Mailing Address - Fax:
Practice Address - Street 1:24 SOUTHMAYD STREET
Practice Address - Street 2:#5
Practice Address - City:CAMPTON
Practice Address - State:NH
Practice Address - Zip Code:03223
Practice Address - Country:US
Practice Address - Phone:978-504-1435
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-11-18
Last Update Date:2020-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1171401041C0700X
NH21691041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical