Provider Demographics
NPI:1871791970
Name:BRESNAHANBALL, JOANNE (MLADC)
Entity type:Individual
Prefix:
First Name:JOANNE
Middle Name:
Last Name:BRESNAHANBALL
Suffix:
Gender:F
Credentials:MLADC
Other - Prefix:MRS
Other - First Name:JOANNE
Other - Middle Name:
Other - Last Name:BRESNAHAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MLADC
Mailing Address - Street 1:272 APPLETREE RD
Mailing Address - Street 2:
Mailing Address - City:AUBURN
Mailing Address - State:NH
Mailing Address - Zip Code:03032-3147
Mailing Address - Country:US
Mailing Address - Phone:603-965-6477
Mailing Address - Fax:
Practice Address - Street 1:66 PROSPECT ST
Practice Address - Street 2:
Practice Address - City:MANCHESTER
Practice Address - State:NH
Practice Address - Zip Code:03104-3506
Practice Address - Country:US
Practice Address - Phone:603-965-6477
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-10
Last Update Date:2011-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA623101YA0400X
NH0589101YA0400X
NH0033101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)