Provider Demographics
NPI:1760237614
Name:LAURO, JENNIFER PATRICIA (LICSW)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:PATRICIA
Last Name:LAURO
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 1:450 GROUT RD
Mailing Address - Street 2:
Mailing Address - City:PERKINSVILLE
Mailing Address - State:VT
Mailing Address - Zip Code:05151-9683
Mailing Address - Country:US
Mailing Address - Phone:802-281-8411
Mailing Address - Fax:
Practice Address - Street 1:1 MEDICAL CENTER DR
Practice Address - Street 2:
Practice Address - City:LEBANON
Practice Address - State:NH
Practice Address - Zip Code:03756-1000
Practice Address - Country:US
Practice Address - Phone:603-650-5000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-04-23
Last Update Date:2024-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH49141041C0700X
NH14391041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical