Provider Demographics
NPI:1467479360
Name:CONNOR, LAURA MARIE (ED D)
Entity Type:Individual
Prefix:DR
First Name:LAURA
Middle Name:MARIE
Last Name:CONNOR
Suffix:
Gender:F
Credentials:ED D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:278 LAFAYETTE RD
Mailing Address - Street 2:BLDG E WEST ENTRY
Mailing Address - City:PORTSMOUTH
Mailing Address - State:NH
Mailing Address - Zip Code:03801
Mailing Address - Country:US
Mailing Address - Phone:603-436-6887
Mailing Address - Fax:603-436-5530
Practice Address - Street 1:278 LAFAYETTE RD
Practice Address - Street 2:BLDG E WEST ENTRY
Practice Address - City:PORTSMOUTH
Practice Address - State:NH
Practice Address - Zip Code:03801
Practice Address - Country:US
Practice Address - Phone:603-436-6887
Practice Address - Fax:603-436-5530
Is Sole Proprietor?:No
Enumeration Date:2006-07-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH302103T00000X
VA0810003525103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH0602279Y0NH01OtherANTHEM BLUE CROSS
NH80002279Medicaid
NH0602279Y0NH01OtherANTHEM BLUE CROSS