Provider Demographics
NPI:1992894810
Name:HANKS, LAURIE FARR (MA, CAS)
Entity type:Individual
Prefix:MRS
First Name:LAURIE
Middle Name:FARR
Last Name:HANKS
Suffix:
Gender:F
Credentials:MA, CAS
Other - Prefix:MISS
Other - First Name:LAURIE
Other - Middle Name:POOLE
Other - Last Name:FARR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MA, CAS
Mailing Address - Street 1:132 BURPEE HILL RD
Mailing Address - Street 2:
Mailing Address - City:GRANTHAM
Mailing Address - State:NH
Mailing Address - Zip Code:03753
Mailing Address - Country:US
Mailing Address - Phone:603-863-1239
Mailing Address - Fax:
Practice Address - Street 1:85 N MAIN ST
Practice Address - Street 2:
Practice Address - City:WHITE RIVER JUNCTION
Practice Address - State:VT
Practice Address - Zip Code:05001-7134
Practice Address - Country:US
Practice Address - Phone:603-863-1239
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-11
Last Update Date:2013-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool