Provider Demographics
NPI:1013961499
Name:GAGNON, BETH (LICSW)
Entity Type:Individual
Prefix:MRS
First Name:BETH
Middle Name:
Last Name:GAGNON
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:MS
Other - First Name:BETH
Other - Middle Name:
Other - Last Name:MACKEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LICSW
Mailing Address - Street 1:15 ERMER RD
Mailing Address - Street 2:SUITE 208
Mailing Address - City:SALEM
Mailing Address - State:NH
Mailing Address - Zip Code:03079-1271
Mailing Address - Country:US
Mailing Address - Phone:603-898-3388
Mailing Address - Fax:
Practice Address - Street 1:15 ERMER RD
Practice Address - Street 2:SUITE 208
Practice Address - City:SALEM
Practice Address - State:NH
Practice Address - Zip Code:03079-1271
Practice Address - Country:US
Practice Address - Phone:603-898-3388
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH1312104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker