Provider Demographics
NPI:1881293413
Name:CHARBONNIER, TAYLOR LAUREN (LCSW)
Entity type:Individual
Prefix:
First Name:TAYLOR
Middle Name:LAUREN
Last Name:CHARBONNIER
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:46 OLD DERRY RD
Mailing Address - Street 2:
Mailing Address - City:HUDSON
Mailing Address - State:NH
Mailing Address - Zip Code:03051-3302
Mailing Address - Country:US
Mailing Address - Phone:603-305-4670
Mailing Address - Fax:
Practice Address - Street 1:336 CENTRAL ST
Practice Address - Street 2:
Practice Address - City:LOWELL
Practice Address - State:MA
Practice Address - Zip Code:01852-2609
Practice Address - Country:US
Practice Address - Phone:978-674-6700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-10-24
Last Update Date:2020-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA334076104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA224076Medicaid