Provider Demographics
NPI:1891050530
Name:LARA KROODSMA, PSYD, PLLC
Entity Type:Organization
Organization Name:LARA KROODSMA, PSYD, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICENSED PSYCHOLOGIST
Authorized Official - Prefix:
Authorized Official - First Name:LARA
Authorized Official - Middle Name:
Authorized Official - Last Name:KROODSMA
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:603-848-3387
Mailing Address - Street 1:25B STEELE RD
Mailing Address - Street 2:
Mailing Address - City:PETERBOROUGH
Mailing Address - State:NH
Mailing Address - Zip Code:03458
Mailing Address - Country:US
Mailing Address - Phone:603-848-3387
Mailing Address - Fax:866-831-4172
Practice Address - Street 1:25B STEELE RD
Practice Address - Street 2:
Practice Address - City:PETERBOROUGH
Practice Address - State:NH
Practice Address - Zip Code:03458
Practice Address - Country:US
Practice Address - Phone:603-848-3387
Practice Address - Fax:866-831-4172
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-07-09
Last Update Date:2012-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH1189251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health