Provider Demographics
NPI:1750555942
Name:KENISON, LINDA B (LICSW, LADC)
Entity type:Individual
Prefix:
First Name:LINDA
Middle Name:B
Last Name:KENISON
Suffix:
Gender:F
Credentials:LICSW, LADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:235 HANOVER ST
Mailing Address - Street 2:
Mailing Address - City:MANCHESTER
Mailing Address - State:NH
Mailing Address - Zip Code:03104-6115
Mailing Address - Country:US
Mailing Address - Phone:603-622-3020
Mailing Address - Fax:603-622-4043
Practice Address - Street 1:235 HANOVER ST
Practice Address - Street 2:
Practice Address - City:MANCHESTER
Practice Address - State:NH
Practice Address - Zip Code:03104-6115
Practice Address - Country:US
Practice Address - Phone:603-622-3020
Practice Address - Fax:603-622-4043
Is Sole Proprietor?:No
Enumeration Date:2008-04-17
Last Update Date:2008-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH0403101YA0400X
NH3961041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical