Provider Demographics
NPI:1699873810
Name:ALLEN, LAURENE (LICSW)
Entity type:Individual
Prefix:
First Name:LAURENE
Middle Name:
Last Name:ALLEN
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 1:16 ELM STREET
Mailing Address - Street 2:
Mailing Address - City:MILFORD
Mailing Address - State:NH
Mailing Address - Zip Code:03055
Mailing Address - Country:US
Mailing Address - Phone:603-672-5005
Mailing Address - Fax:603-672-6501
Practice Address - Street 1:FAMILY GUIDANCE CENTER OF MILFORD
Practice Address - Street 2:16 ELM STREET
Practice Address - City:MILFORD
Practice Address - State:NH
Practice Address - Zip Code:03055
Practice Address - Country:US
Practice Address - Phone:603-672-5005
Practice Address - Fax:603-672-6501
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NHLICSW 963104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
2053065OtherCIGNA
012110OtherHARVARD PILGRIM
416775OtherVALUE OPTIONS
14Y000930NH01OtherANTHEM BCBS
NH30420983Medicaid
416775OtherVALUE OPTIONS