Provider Demographics
NPI:1336616374
Name:WEDLOCK, ROBIN ELIZABETH (LICSW)
Entity Type:Individual
Prefix:MS
First Name:ROBIN
Middle Name:ELIZABETH
Last Name:WEDLOCK
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 1:52 NASHUA ST
Mailing Address - Street 2:
Mailing Address - City:MILFORD
Mailing Address - State:NH
Mailing Address - Zip Code:03055-3717
Mailing Address - Country:US
Mailing Address - Phone:603-461-1421
Mailing Address - Fax:
Practice Address - Street 1:52 NASHUA ST
Practice Address - Street 2:
Practice Address - City:MILFORD
Practice Address - State:NH
Practice Address - Zip Code:03055-3717
Practice Address - Country:US
Practice Address - Phone:603-461-1421
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-10-29
Last Update Date:2023-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH29491041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH2165OtherLICSW