Provider Demographics
NPI:1932317286
Name:CRIDER, LAURIE M (PSYD)
Entity Type:Individual
Prefix:DR
First Name:LAURIE
Middle Name:M
Last Name:CRIDER
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20 MAIN ST
Mailing Address - Street 2:SUITE 1
Mailing Address - City:KEENE
Mailing Address - State:NH
Mailing Address - Zip Code:03431-3784
Mailing Address - Country:US
Mailing Address - Phone:603-762-2128
Mailing Address - Fax:603-585-9436
Practice Address - Street 1:20 MAIN ST
Practice Address - Street 2:SUITE 1
Practice Address - City:KEENE
Practice Address - State:NH
Practice Address - Zip Code:03431-3784
Practice Address - Country:US
Practice Address - Phone:603-762-2128
Practice Address - Fax:603-585-9436
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-18
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NHNH 956103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH30424610Medicaid
NH2067365Medicare UPIN
NH06Y001125NH04Medicare UPIN
NH30424610Medicaid