Provider Demographics
NPI:1770979114
Name:PRINCE, AMY L (LICSW)
Entity type:Individual
Prefix:MS
First Name:AMY
Middle Name:L
Last Name:PRINCE
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 1:22 GLIDDEN RD
Mailing Address - Street 2:
Mailing Address - City:GILFORD
Mailing Address - State:NH
Mailing Address - Zip Code:03249-7874
Mailing Address - Country:US
Mailing Address - Phone:603-556-4086
Mailing Address - Fax:603-556-4086
Practice Address - Street 1:501 UNION AVE
Practice Address - Street 2:
Practice Address - City:LACONIA
Practice Address - State:NH
Practice Address - Zip Code:03246-2867
Practice Address - Country:US
Practice Address - Phone:603-556-4086
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-04-13
Last Update Date:2019-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH16341041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical