Provider Demographics
NPI:1215031802
Name:BRESNAHAN, JAMES P JR (LMFT LMHC LADAC1 CAD)
Entity Type:Individual
Prefix:MR
First Name:JAMES
Middle Name:P
Last Name:BRESNAHAN
Suffix:JR
Gender:M
Credentials:LMFT LMHC LADAC1 CAD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:585 LINCOLN ST
Mailing Address - Street 2:
Mailing Address - City:WORCESTER
Mailing Address - State:MA
Mailing Address - Zip Code:01605
Mailing Address - Country:US
Mailing Address - Phone:508-854-3320
Mailing Address - Fax:508-753-5051
Practice Address - Street 1:105 MERRICK ST
Practice Address - Street 2:US
Practice Address - City:WORCESTER
Practice Address - State:MA
Practice Address - Zip Code:01609
Practice Address - Country:US
Practice Address - Phone:508-797-6100
Practice Address - Fax:508-797-0693
Is Sole Proprietor?:No
Enumeration Date:2006-09-12
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA4524101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA1306421Medicaid
MA1308785OtherMCD MH BCBS MH M18684
MA2220002001OtherBCBS SA
MAY10400Medicare ID - Type Unspecified