Provider Demographics
NPI:1619416138
Name:MCENRUE, MARIANNE (LICSW)
Entity Type:Individual
Prefix:
First Name:MARIANNE
Middle Name:
Last Name:MCENRUE
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 1:35 NEWPORT RD
Mailing Address - Street 2:
Mailing Address - City:NEW LONDON
Mailing Address - State:NH
Mailing Address - Zip Code:03257-5413
Mailing Address - Country:US
Mailing Address - Phone:603-865-1321
Mailing Address - Fax:
Practice Address - Street 1:35 NEWPORT RD
Practice Address - Street 2:
Practice Address - City:NEW LONDON
Practice Address - State:NH
Practice Address - Zip Code:03257-5413
Practice Address - Country:US
Practice Address - Phone:603-865-1321
Practice Address - Fax:603-865-1327
Is Sole Proprietor?:No
Enumeration Date:2017-02-16
Last Update Date:2020-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT089.00954901041C0700X
NH20021041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical