Provider Demographics
NPI:1871967380
Name:HANNAN, JACLYN (LICSW)
Entity type:Individual
Prefix:
First Name:JACLYN
Middle Name:
Last Name:HANNAN
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15 ERMER RD
Mailing Address - Street 2:SUITE 215
Mailing Address - City:SALEM
Mailing Address - State:NH
Mailing Address - Zip Code:03079-1271
Mailing Address - Country:US
Mailing Address - Phone:603-890-6767
Mailing Address - Fax:603-893-6767
Practice Address - Street 1:15 ERMER RD
Practice Address - Street 2:SUITE 215
Practice Address - City:SALEM
Practice Address - State:NH
Practice Address - Zip Code:03079-1271
Practice Address - Country:US
Practice Address - Phone:603-890-6767
Practice Address - Fax:603-893-6767
Is Sole Proprietor?:Yes
Enumeration Date:2015-11-20
Last Update Date:2015-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH18991041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical