Provider Demographics
NPI:1134219678
Name:DOUBLEDAY, JOAN KUNDIN (LICSW)
Entity type:Individual
Prefix:MS
First Name:JOAN
Middle Name:KUNDIN
Last Name:DOUBLEDAY
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 1:20 W PARK ST
Mailing Address - Street 2:
Mailing Address - City:LEBANON
Mailing Address - State:NH
Mailing Address - Zip Code:03766-1378
Mailing Address - Country:US
Mailing Address - Phone:603-448-9925
Mailing Address - Fax:802-295-2441
Practice Address - Street 1:20 W PARK ST
Practice Address - Street 2:
Practice Address - City:LEBANON
Practice Address - State:NH
Practice Address - Zip Code:03766-1378
Practice Address - Country:US
Practice Address - Phone:603-448-9925
Practice Address - Fax:802-295-2441
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH239101YM0800X
VT181101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT1010107Medicaid
NH30007245Medicaid
VTDOUB09984OtherBC/BS OF VT ID#
VT181OtherLICENSE #
NH239OtherLICENSE #
VT1010107Medicaid