Provider Demographics
NPI:1730543356
Name:DUCKROW FONDA, SERENA D (LCMHC, ATR-BCCS)
Entity type:Individual
Prefix:DR
First Name:SERENA
Middle Name:D
Last Name:DUCKROW FONDA
Suffix:
Gender:F
Credentials:LCMHC, ATR-BCCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:114 DUDLEY HILL RD
Mailing Address - Street 2:
Mailing Address - City:PEMBROKE
Mailing Address - State:NH
Mailing Address - Zip Code:03275-2908
Mailing Address - Country:US
Mailing Address - Phone:603-953-5525
Mailing Address - Fax:
Practice Address - Street 1:114 DUDLEY HILL RD
Practice Address - Street 2:
Practice Address - City:PEMBROKE
Practice Address - State:NH
Practice Address - Zip Code:03275-2908
Practice Address - Country:US
Practice Address - Phone:603-953-5525
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-04-09
Last Update Date:2020-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH1730543356Medicaid
NH101YM0800XMedicaid