Provider Demographics
NPI:1952453060
Name:PRIOR, AUTUMN DAMARA (LICSW)
Entity Type:Individual
Prefix:MS
First Name:AUTUMN
Middle Name:DAMARA
Last Name:PRIOR
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 1:5500 N MAIN ST
Mailing Address - Street 2:BLDG 15 APT 109
Mailing Address - City:FALL RIVER
Mailing Address - State:MA
Mailing Address - Zip Code:02720-2061
Mailing Address - Country:US
Mailing Address - Phone:401-862-2717
Mailing Address - Fax:
Practice Address - Street 1:106 SPRING ST
Practice Address - Street 2:SUITE #210
Practice Address - City:NEW BEDFORD
Practice Address - State:MA
Practice Address - Zip Code:02740-5951
Practice Address - Country:US
Practice Address - Phone:508-837-9587
Practice Address - Fax:508-300-8808
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-17
Last Update Date:2016-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2144131041C0700X
MA1143101041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical