Provider Demographics
NPI:1982082004
Name:KLASEN-ORR, ERIN MARIE (LICSW)
Entity Type:Individual
Prefix:
First Name:ERIN
Middle Name:MARIE
Last Name:KLASEN-ORR
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:ERIN
Other - Middle Name:MARIE
Other - Last Name:KLASEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LICSW
Mailing Address - Street 1:258 HIGHLAND STREET
Mailing Address - Street 2:
Mailing Address - City:PLYMOUTH
Mailing Address - State:NH
Mailing Address - Zip Code:03264
Mailing Address - Country:US
Mailing Address - Phone:307-690-9204
Mailing Address - Fax:603-536-1175
Practice Address - Street 1:258 HIGHLAND STREET
Practice Address - Street 2:
Practice Address - City:PLYMOUTH
Practice Address - State:NH
Practice Address - Zip Code:03264
Practice Address - Country:US
Practice Address - Phone:307-690-9204
Practice Address - Fax:603-536-1175
Is Sole Proprietor?:Yes
Enumeration Date:2015-05-08
Last Update Date:2018-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH18551041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
13554186OtherCAQH
NH3101813Medicaid