Provider Demographics
NPI:1144571217
Name:GULLA, LAUREN (LICSW)
Entity Type:Individual
Prefix:MRS
First Name:LAUREN
Middle Name:
Last Name:GULLA
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 1:1145 SAGAMORE AVE
Mailing Address - Street 2:
Mailing Address - City:PORTSMOUTH
Mailing Address - State:NH
Mailing Address - Zip Code:03801-5503
Mailing Address - Country:US
Mailing Address - Phone:603-431-6703
Mailing Address - Fax:603-430-3753
Practice Address - Street 1:1145 SAGAMORE AVE
Practice Address - Street 2:
Practice Address - City:PORTSMOUTH
Practice Address - State:NH
Practice Address - Zip Code:03801-5503
Practice Address - Country:US
Practice Address - Phone:603-431-6703
Practice Address - Fax:603-430-3753
Is Sole Proprietor?:Yes
Enumeration Date:2012-09-28
Last Update Date:2015-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH99003227Medicaid
NH99003227Medicaid