Individual
ELIZABETH GANNON-MOFFETT
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LICSW
Contact information
Practice address
3 FRONT ST, SUITE 351, ROLLINSFORD, NH 03869-7001
(603) 312-0731
Mailing address
PO BOX 395, ROLLINSFORD, NH 03869-0395
(603) 312-0731
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
1182
NH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
14Y009951NH01
ANTHEM BLUE CROSS
NH
05
—
30423878
—
NH
Enumeration date
07/10/2006
Last updated
07/08/2007
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