Provider Demographics
NPI:1346729175
Name:BROGNA, MELISSA (MLADC)
Entity Type:Individual
Prefix:
First Name:MELISSA
Middle Name:
Last Name:BROGNA
Suffix:
Gender:F
Credentials:MLADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:122 MARKET ST
Mailing Address - Street 2:
Mailing Address - City:MANCHESTER
Mailing Address - State:NH
Mailing Address - Zip Code:03101-1952
Mailing Address - Country:US
Mailing Address - Phone:603-641-9441
Mailing Address - Fax:
Practice Address - Street 1:161 S BEECH ST
Practice Address - Street 2:
Practice Address - City:MANCHESTER
Practice Address - State:NH
Practice Address - Zip Code:03103-5708
Practice Address - Country:US
Practice Address - Phone:603-641-9441
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-13
Last Update Date:2018-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH1034101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)