Provider Demographics
NPI:1093868994
Name:HANNON, JAMES THADDEUS
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:THADDEUS
Last Name:HANNON
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:33 BEDFORD ST
Mailing Address - Street 2:
Mailing Address - City:CONCORD
Mailing Address - State:MA
Mailing Address - Zip Code:01742-1874
Mailing Address - Country:US
Mailing Address - Phone:978-505-9038
Mailing Address - Fax:
Practice Address - Street 1:33 BEDFORD ST
Practice Address - Street 2:
Practice Address - City:CONCORD
Practice Address - State:MA
Practice Address - Zip Code:01742-1874
Practice Address - Country:US
Practice Address - Phone:978-505-9038
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-22
Last Update Date:2009-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MALADC-I 597101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)