Basic Information
| Provider Information | |||||||||
| NPI: | 1023232865 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MAGUIRE | ||||||||
| FirstName: | ELISABETH | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | |||||||||
| NameSuffix: | |||||||||
| Credential: | LICSW | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | MAGUIRE LARNEY | ||||||||
| OtherFirstName: | ELISABETH | ||||||||
| OtherMiddleName: | |||||||||
| OtherNamePrefix: | |||||||||
| OtherNameSuffix: | |||||||||
| OtherCredential: | |||||||||
| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 77 NORTHEASTERN BLVD STE C | ||||||||
| Address2: | |||||||||
| City: | NASHUA | ||||||||
| State: | NH | ||||||||
| PostalCode: | 030623128 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6038217788 | ||||||||
| FaxNumber: | 6038215620 | ||||||||
| Practice Location | |||||||||
| Address1: | 45 HIGH ST | ||||||||
| Address2: | |||||||||
| City: | NASHUA | ||||||||
| State: | NH | ||||||||
| PostalCode: | 030603312 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6038217788 | ||||||||
| FaxNumber: | 6038215620 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/12/2007 | ||||||||
| LastUpdateDate: | 01/11/2018 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| AuthorizedOfficialTitleorPosition: | |||||||||
| AuthorizedOfficialTelephone: | |||||||||
| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1041C0700X | 1768 | NH | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical | 1041C0700X | 114978 | MA | N | Behavioral Health & Social Service Providers | Social Worker | Clinical |
ID Information
| ID | Type | State | Issuer | Description | 3100491 | 05 | NH | MEDICAID |