Provider Demographics
NPI:1700952868
Name:MUDGE, LAURIE A (LICSW)
Entity Type:Individual
Prefix:
First Name:LAURIE
Middle Name:A
Last Name:MUDGE
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:LAURIE
Other - Middle Name:A
Other - Last Name:MUDGE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LICSW
Mailing Address - Street 1:9 HANOVER ST SUITE 2
Mailing Address - Street 2:WEST CENTRAL SERVICES INC
Mailing Address - City:LEBANON
Mailing Address - State:NH
Mailing Address - Zip Code:03766
Mailing Address - Country:US
Mailing Address - Phone:603-448-0126
Mailing Address - Fax:603-448-6001
Practice Address - Street 1:122 PLEASANT ST
Practice Address - Street 2:CLAREMONT CHILD & FAMILY CTR
Practice Address - City:CLAREMONT
Practice Address - State:NH
Practice Address - Zip Code:03743-2679
Practice Address - Country:US
Practice Address - Phone:603-542-5449
Practice Address - Fax:603-542-5455
Is Sole Proprietor?:No
Enumeration Date:2006-11-28
Last Update Date:2012-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH9341041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical