Provider Demographics
NPI:1609957638
Name:FONDER, STANLEY MICHAEL (MSW,LICSW)
Entity type:Individual
Prefix:MR
First Name:STANLEY
Middle Name:MICHAEL
Last Name:FONDER
Suffix:
Gender:M
Credentials:MSW,LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 282
Mailing Address - Street 2:
Mailing Address - City:WILTON
Mailing Address - State:NH
Mailing Address - Zip Code:03086-0282
Mailing Address - Country:US
Mailing Address - Phone:603-654-4331
Mailing Address - Fax:603-577-9157
Practice Address - Street 1:39 SIMON ST
Practice Address - Street 2:SUITE 2A
Practice Address - City:NASHUA
Practice Address - State:NH
Practice Address - Zip Code:03060-3046
Practice Address - Country:US
Practice Address - Phone:603-888-4347
Practice Address - Fax:603-577-9157
Is Sole Proprietor?:No
Enumeration Date:2006-10-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH7331041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical