Provider Demographics
NPI:1205042421
Name:CHARLENE CURTIS, LLC LICSW
Entity Type:Organization
Organization Name:CHARLENE CURTIS, LLC LICSW
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICSW
Authorized Official - Prefix:MS
Authorized Official - First Name:CHARLENE
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:CURTIS
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:603-673-5003
Mailing Address - Street 1:188 ELM ST
Mailing Address - Street 2:
Mailing Address - City:MILFORD
Mailing Address - State:NH
Mailing Address - Zip Code:03055-4761
Mailing Address - Country:US
Mailing Address - Phone:603-673-5003
Mailing Address - Fax:603-673-3002
Practice Address - Street 1:188 ELM ST
Practice Address - Street 2:
Practice Address - City:MILFORD
Practice Address - State:NH
Practice Address - Zip Code:03055-4761
Practice Address - Country:US
Practice Address - Phone:603-673-5003
Practice Address - Fax:603-673-3002
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-15
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH11429999OtherCAQH
NH30424590Medicaid