Provider Demographics
NPI:1538637228
Name:FORTIER-DUBE, BRENDA (LICSW)
Entity Type:Individual
Prefix:
First Name:BRENDA
Middle Name:
Last Name:FORTIER-DUBE
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 1:218 BICKFORD HILL RD
Mailing Address - Street 2:
Mailing Address - City:FRANCONIA
Mailing Address - State:NH
Mailing Address - Zip Code:03580-4800
Mailing Address - Country:US
Mailing Address - Phone:603-823-9019
Mailing Address - Fax:
Practice Address - Street 1:25 MOUNT EUSTIS RD
Practice Address - Street 2:
Practice Address - City:LITTLETON
Practice Address - State:NH
Practice Address - Zip Code:03561-3712
Practice Address - Country:US
Practice Address - Phone:603-444-2464
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-11-12
Last Update Date:2018-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH20521041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical