Basic Information
| Provider Information | |||||||||
| NPI: | 1730285438 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | AUBRY | ||||||||
| FirstName: | KENNETH | ||||||||
| MiddleName: | |||||||||
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| Credential: | LICSW | ||||||||
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| Mailing Information | |||||||||
| Address1: | 401 CYPRESS ST | ||||||||
| Address2: | |||||||||
| City: | MANCHESTER | ||||||||
| State: | NH | ||||||||
| PostalCode: | 031033628 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6036684111 | ||||||||
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| Practice Location | |||||||||
| Address1: | 9 BLODGET ST | ||||||||
| Address2: | |||||||||
| City: | MANCHESTER | ||||||||
| State: | NH | ||||||||
| PostalCode: | 031043502 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6036684111 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/16/2006 | ||||||||
| LastUpdateDate: | 09/21/2011 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1041C0700X | 91 | NH | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical |
ID Information
| ID | Type | State | Issuer | Description | 020258994-03 | 01 | NH | HARVARD PILGRIM | OTHER | 1039149 | 01 | NH | CIGNA | OTHER | 1405792Y0NH01 | 01 | NH | BLUE CROSS | OTHER |