Healthcare Provider Details

I. General information

NPI: 1144711250
Provider Name (Legal Business Name): BRIANNA ZENKUS LICSW, LADC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/24/2018
Last Update Date: 11/06/2023
Certification Date: 11/06/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

25 S RIVER RD
BEDFORD NH
03110-6708
US

IV. Provider business mailing address

25 S RIVER RD
BEDFORD NH
03110-6708
US

V. Phone/Fax

Practice location:
  • Phone: 603-242-2296
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number1115
License Number StateNH
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number3073
License Number StateNH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: