Provider Demographics
NPI:1447203609
Name:CURTIS, CHARLENE MARIE (LCSW LLC)
Entity Type:Individual
Prefix:MS
First Name:CHARLENE
Middle Name:MARIE
Last Name:CURTIS
Suffix:
Gender:F
Credentials:LCSW LLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:188 ELM STREET
Mailing Address - Street 2:
Mailing Address - City:MILFORD
Mailing Address - State:NH
Mailing Address - Zip Code:03055
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
Practice Address - Country:US
Practice Address - Phone:603-673-5003
Practice Address - Fax:603-673-3002
Is Sole Proprietor?:No
Enumeration Date:2006-05-18
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH10771041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
30422137OtherCLPA
30423250OtherCMRC
NH30423250Medicaid
NH30424590Medicaid
NHRE6856Medicare ID - Type Unspecified
NH30424590Medicaid