Provider Demographics
NPI:1629181722
Name:JUE, CAROL SWENSON (LICSW)
Entity Type:Individual
Prefix:MS
First Name:CAROL
Middle Name:SWENSON
Last Name:JUE
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 1:23 RIDGEWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:KEENE
Mailing Address - State:NH
Mailing Address - Zip Code:03431-2869
Mailing Address - Country:US
Mailing Address - Phone:603-283-1504
Mailing Address - Fax:
Practice Address - Street 1:64 MAIN ST
Practice Address - Street 2:SUITE 301
Practice Address - City:KEENE
Practice Address - State:NH
Practice Address - Zip Code:03431-3701
Practice Address - Country:US
Practice Address - Phone:603-283-1504
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-16
Last Update Date:2007-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH4911041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH81263595Medicaid
NH81263595Medicaid