Provider Demographics
NPI:1225770928
Name:GRISWOLD, BROOKE (MS)
Entity Type:Individual
Prefix:
First Name:BROOKE
Middle Name:
Last Name:GRISWOLD
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:BROOKE
Other - Middle Name:
Other - Last Name:KENNEDY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:835 US ROUTE 4
Mailing Address - Street 2:
Mailing Address - City:CANAAN
Mailing Address - State:NH
Mailing Address - Zip Code:03741-7880
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:24 HANOVER ST # 212-B
Practice Address - Street 2:
Practice Address - City:LEBANON
Practice Address - State:NH
Practice Address - Zip Code:03766-1334
Practice Address - Country:US
Practice Address - Phone:603-787-5778
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-04-12
Last Update Date:2024-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT097.0135286101YM0800X
NH2828101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health