Provider Demographics
NPI:1043920069
Name:MENARD, GRACE E M
Entity type:Individual
Prefix:
First Name:GRACE
Middle Name:E M
Last Name:MENARD
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:446 N STATE ST # 3
Mailing Address - Street 2:
Mailing Address - City:CONCORD
Mailing Address - State:NH
Mailing Address - Zip Code:03301-3245
Mailing Address - Country:US
Mailing Address - Phone:603-803-1238
Mailing Address - Fax:
Practice Address - Street 1:8 OLD SUNCOOK RD
Practice Address - Street 2:
Practice Address - City:CONCORD
Practice Address - State:NH
Practice Address - Zip Code:03301-7312
Practice Address - Country:US
Practice Address - Phone:603-488-5008
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-11-30
Last Update Date:2022-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician