Provider Demographics
NPI:1902062979
Name:GAULT, EDITH J (LICSW)
Entity Type:Individual
Prefix:MRS
First Name:EDITH
Middle Name:J
Last Name:GAULT
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 1:67 COMMUNICATIONS WAY
Mailing Address - Street 2:
Mailing Address - City:LACONIA
Mailing Address - State:NH
Mailing Address - Zip Code:03246
Mailing Address - Country:US
Mailing Address - Phone:603-524-8811
Mailing Address - Fax:603-524-0272
Practice Address - Street 1:67 COMMUNICATIONS WAY
Practice Address - Street 2:
Practice Address - City:LACONIA
Practice Address - State:NH
Practice Address - Zip Code:03246
Practice Address - Country:US
Practice Address - Phone:603-524-8811
Practice Address - Fax:603-524-0272
Is Sole Proprietor?:No
Enumeration Date:2008-07-30
Last Update Date:2008-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH1094104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker