Provider Demographics
NPI:1265643126
Name:PUTNAM, LUCY (LCMHC)
Entity Type:Individual
Prefix:
First Name:LUCY
Middle Name:
Last Name:PUTNAM
Suffix:
Gender:F
Credentials:LCMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:113 CROSBY RD
Mailing Address - Street 2:
Mailing Address - City:DOVER
Mailing Address - State:NH
Mailing Address - Zip Code:03820-4370
Mailing Address - Country:US
Mailing Address - Phone:603-749-4015
Mailing Address - Fax:
Practice Address - Street 1:25 OLD DOVER RD
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NH
Practice Address - Zip Code:03867-3464
Practice Address - Country:US
Practice Address - Phone:603-335-6470
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH61106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH30931444Medicaid
NHRE6496Medicare ID - Type Unspecified