Healthcare Provider Details

I. General information

NPI: 1508345869
Provider Name (Legal Business Name): VINCENT HANEY LCMHC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/08/2018
Last Update Date: 09/25/2024
Certification Date: 09/25/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15 NELSON ST FL 2MD
MANCHESTER NH
03103-2706
US

IV. Provider business mailing address

552 S MAIN ST
MANCHESTER NH
03102-5132
US

V. Phone/Fax

Practice location:
  • Phone: 603-689-7890
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number4769
License Number StateNH
# 2
Primary TaxonomyN
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: