Provider Demographics
NPI:1922424225
Name:AUFFANT, LAURIE JEAN (LICSW)
Entity Type:Individual
Prefix:
First Name:LAURIE
Middle Name:JEAN
Last Name:AUFFANT
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 1:234 LITTLETON RD STE 1D
Mailing Address - Street 2:
Mailing Address - City:WESTFORD
Mailing Address - State:MA
Mailing Address - Zip Code:01886-3530
Mailing Address - Country:US
Mailing Address - Phone:978-995-2163
Mailing Address - Fax:978-710-7353
Practice Address - Street 1:234 LITTLETON RD STE 1D
Practice Address - Street 2:
Practice Address - City:WESTFORD
Practice Address - State:MA
Practice Address - Zip Code:01886-3530
Practice Address - Country:US
Practice Address - Phone:978-995-2163
Practice Address - Fax:978-710-7353
Is Sole Proprietor?:Yes
Enumeration Date:2014-03-11
Last Update Date:2019-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA3263771041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA1305638Medicaid