Provider Demographics
NPI:1538515929
Name:KILGORE, LAURIE (LICSW)
Entity Type:Individual
Prefix:
First Name:LAURIE
Middle Name:
Last Name:KILGORE
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 1:1080 WASHINGTON ST
Mailing Address - Street 2:
Mailing Address - City:HANOVER
Mailing Address - State:MA
Mailing Address - Zip Code:02339-1600
Mailing Address - Country:US
Mailing Address - Phone:781-826-2393
Mailing Address - Fax:
Practice Address - Street 1:1080 WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:HANOVER
Practice Address - State:MA
Practice Address - Zip Code:02339-1600
Practice Address - Country:US
Practice Address - Phone:781-826-2393
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-05-04
Last Update Date:2016-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA10167081041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical