Provider Demographics
NPI:1164067369
Name:MACRI, JOHANNA (MALCMHC)
Entity Type:Individual
Prefix:
First Name:JOHANNA
Middle Name:
Last Name:MACRI
Suffix:
Gender:F
Credentials:MALCMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23 CENTRAL SQ STE 300
Mailing Address - Street 2:
Mailing Address - City:KEENE
Mailing Address - State:NH
Mailing Address - Zip Code:03431-3707
Mailing Address - Country:US
Mailing Address - Phone:603-355-2244
Mailing Address - Fax:
Practice Address - Street 1:23 CENTRAL SQ STE 300
Practice Address - Street 2:
Practice Address - City:KEENE
Practice Address - State:NH
Practice Address - Zip Code:03431-3707
Practice Address - Country:US
Practice Address - Phone:603-355-2244
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-11-12
Last Update Date:2019-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH2197101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty