Provider Demographics
NPI:1700873635
Name:LIBBY, KRISTEN ES (LICSW)
Entity Type:Individual
Prefix:MS
First Name:KRISTEN
Middle Name:ES
Last Name:LIBBY
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:MS
Other - First Name:KRISTEN
Other - Middle Name:E
Other - Last Name:SEDERQUIST
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LICSW
Mailing Address - Street 1:PO BOX 3300
Mailing Address - Street 2:
Mailing Address - City:MANCHESTER
Mailing Address - State:NH
Mailing Address - Zip Code:03105-3300
Mailing Address - Country:US
Mailing Address - Phone:603-645-5977
Mailing Address - Fax:603-645-5980
Practice Address - Street 1:138 WEBSTER ST
Practice Address - Street 2:
Practice Address - City:MANCHESTER
Practice Address - State:NH
Practice Address - Zip Code:03104-2512
Practice Address - Country:US
Practice Address - Phone:603-645-5977
Practice Address - Fax:603-645-5980
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-10-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH898104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
144001671NH01OtherANTHEM
NH30422713Medicaid
144001671NH01OtherANTHEM