Individual
MS. ELLEN MARIE DEZIECK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MSW
Contact information
Practice address
1 SCHOOL STREET, LEBANON, NH 03766
(603) 448-6385
Mailing address
PO BOX 1342, LEBANON, NH 03766
(603) 448-6385
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
255
NH
Other
Enumeration date
04/13/2007
Last updated
07/08/2007
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