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NPI Code Detail

MEDICARE: JOANNE BRESNAHANBALL MLADC

MEDICARE: JOANNE BRESNAHANBALL MLADC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1101YA0400XAddiction (Substance Use Disorder) Counselor623MA
2101YA0400XAddiction (Substance Use Disorder) Counselor0589NH
3101YA0400XAddiction (Substance Use Disorder) Counselor0033NH

General Provider Information

NPI Number : 1871791970
Entity Type Code : Individual
Provider Name (Legal Business Name) : JOANNE BRESNAHANBALL MLADC
Provider Business Mailing Address
First Line : 272 APPLETREE RD
Second Line :
City : AUBURN
State : NH
Zip : 03032-3147
Country : US
Telephone Number : 603-965-6477
Fax Number :
Provider Business Practice Location Address
First Line : 66 PROSPECT ST
Second Line :
City : MANCHESTER
State : NH
Zip : 03104-3506
Country : US
Telephone Number : 603-965-6477
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/10/2007
Last Update Date : 08/03/2011

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