Provider Demographics
NPI:1275147928
Name:SPADAFORE, LAURYN (MED)
Entity Type:Individual
Prefix:
First Name:LAURYN
Middle Name:
Last Name:SPADAFORE
Suffix:
Gender:F
Credentials:MED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:43 LOVERIN HILL RD
Mailing Address - Street 2:
Mailing Address - City:SALISBURY
Mailing Address - State:NH
Mailing Address - Zip Code:03268-5111
Mailing Address - Country:US
Mailing Address - Phone:603-229-7005
Mailing Address - Fax:
Practice Address - Street 1:14 CHURCH ST
Practice Address - Street 2:
Practice Address - City:WARNER
Practice Address - State:NH
Practice Address - Zip Code:03278-4527
Practice Address - Country:US
Practice Address - Phone:603-456-2241
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-09-01
Last Update Date:2020-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH113772103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool