Provider Demographics
NPI:1518140649
Name:SINCLAIR, LAURA MARIE
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:MARIE
Last Name:SINCLAIR
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:LAURA
Other - Middle Name:MARIE
Other - Last Name:WICKMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1145 SAGAMORE AVE
Mailing Address - Street 2:
Mailing Address - City:PORTSMOUTH
Mailing Address - State:NH
Mailing Address - Zip Code:03801-5503
Mailing Address - Country:US
Mailing Address - Phone:603-431-6703
Mailing Address - Fax:603-433-5078
Practice Address - Street 1:1145 SAGAMORE AVE
Practice Address - Street 2:
Practice Address - City:PORTSMOUTH
Practice Address - State:NH
Practice Address - Zip Code:03801-5503
Practice Address - Country:US
Practice Address - Phone:603-431-6703
Practice Address - Fax:603-433-5078
Is Sole Proprietor?:Yes
Enumeration Date:2007-12-12
Last Update Date:2022-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH7706655Y0NH01OtherBHN
NH99003227Medicaid
NHNH3227Medicare Oscar/Certification