Provider Demographics
NPI:1407605132
Name:AWALT, PARIS SUSANNAH (LICSW)
Entity type:Individual
Prefix:
First Name:PARIS
Middle Name:SUSANNAH
Last Name:AWALT
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:29 ROCKINGHAM ST
Mailing Address - Street 2:
Mailing Address - City:CONCORD
Mailing Address - State:NH
Mailing Address - Zip Code:03301-2645
Mailing Address - Country:US
Mailing Address - Phone:603-219-4528
Mailing Address - Fax:
Practice Address - Street 1:6 CHENELL DR STE 100
Practice Address - Street 2:
Practice Address - City:CONCORD
Practice Address - State:NH
Practice Address - Zip Code:03301-8514
Practice Address - Country:US
Practice Address - Phone:603-219-4528
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-05-15
Last Update Date:2024-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH19571041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical