Provider Demographics
NPI:1922054857
Name:IOSUE, DOUGLAS LLOYD (LICSW)
Entity Type:Individual
Prefix:MR
First Name:DOUGLAS
Middle Name:LLOYD
Last Name:IOSUE
Suffix:
Gender:M
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17 93RD ST
Mailing Address - Street 2:
Mailing Address - City:KEENE
Mailing Address - State:NH
Mailing Address - Zip Code:03431-3748
Mailing Address - Country:US
Mailing Address - Phone:603-357-4400
Mailing Address - Fax:603-357-6859
Practice Address - Street 1:64 MAIN ST
Practice Address - Street 2:SUITE 201
Practice Address - City:KEENE
Practice Address - State:NH
Practice Address - Zip Code:03431-3701
Practice Address - Country:US
Practice Address - Phone:603-357-4400
Practice Address - Fax:603-357-6859
Is Sole Proprietor?:No
Enumeration Date:2006-05-25
Last Update Date:2007-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH908104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH81263595Medicaid
NH81263595Medicaid