Provider Demographics
NPI:1376898023
Name:EKBERG, LAURIE ANN (LICSW)
Entity Type:Individual
Prefix:
First Name:LAURIE
Middle Name:ANN
Last Name:EKBERG
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:PO BOX 3486
Mailing Address - Street 2:
Mailing Address - City:MANCHESTER
Mailing Address - State:NH
Mailing Address - Zip Code:03105-3486
Mailing Address - Country:US
Mailing Address - Phone:603-998-5186
Mailing Address - Fax:866-753-1727
Practice Address - Street 1:35 THIRD ST
Practice Address - Street 2:
Practice Address - City:DOVER
Practice Address - State:NH
Practice Address - Zip Code:03820-3316
Practice Address - Country:US
Practice Address - Phone:603-998-5186
Practice Address - Fax:866-753-1727
Is Sole Proprietor?:No
Enumeration Date:2012-07-18
Last Update Date:2012-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH11291041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical