Provider Demographics
NPI:1750546487
Name:DAIGNEAULT, SHIRLEY B (LICSW)
Entity type:Individual
Prefix:
First Name:SHIRLEY
Middle Name:B
Last Name:DAIGNEAULT
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 1:650 ATWELL HILL RD
Mailing Address - Street 2:
Mailing Address - City:WENTWORTH
Mailing Address - State:NH
Mailing Address - Zip Code:03282-3213
Mailing Address - Country:US
Mailing Address - Phone:240-401-1870
Mailing Address - Fax:
Practice Address - Street 1:258 HIGHLAND ST
Practice Address - Street 2:
Practice Address - City:PLYMOUTH
Practice Address - State:NH
Practice Address - Zip Code:03264-3612
Practice Address - Country:US
Practice Address - Phone:240-401-1870
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-07-22
Last Update Date:2016-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH14211041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical