Provider Demographics
NPI:1376167734
Name:BRENNAN, HANNAH GRACE
Entity Type:Individual
Prefix:
First Name:HANNAH
Middle Name:GRACE
Last Name:BRENNAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:HANNAH
Other - Middle Name:
Other - Last Name:GRIFFIN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:132 S. MAIN STREET
Mailing Address - Street 2:SUITE 100
Mailing Address - City:WHITE RIVER JCT.
Mailing Address - State:VT
Mailing Address - Zip Code:05001-7234
Mailing Address - Country:US
Mailing Address - Phone:802-295-3031
Mailing Address - Fax:802-281-7080
Practice Address - Street 1:132 S. MAIN STREET
Practice Address - Street 2:SUITE 100
Practice Address - City:WHITE RIVER JCT.
Practice Address - State:VT
Practice Address - Zip Code:05001-7234
Practice Address - Country:US
Practice Address - Phone:802-295-3031
Practice Address - Fax:802-281-7080
Is Sole Proprietor?:No
Enumeration Date:2020-06-02
Last Update Date:2024-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT097.0135074101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL474579189001Medicaid