Provider Demographics
NPI:1417108986
Name:HANNON, JOANNA ST PIERRE (LICSW, CADAC)
Entity Type:Individual
Prefix:MS
First Name:JOANNA
Middle Name:ST PIERRE
Last Name:HANNON
Suffix:
Gender:F
Credentials:LICSW, CADAC
Other - Prefix:MS
Other - First Name:JOANNA
Other - Middle Name:
Other - Last Name:ST PIERRE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LICSW
Mailing Address - Street 1:12 BARDWELL ST
Mailing Address - Street 2:
Mailing Address - City:JAMAICA PLAIN
Mailing Address - State:MA
Mailing Address - Zip Code:02130-3111
Mailing Address - Country:US
Mailing Address - Phone:617-680-9670
Mailing Address - Fax:
Practice Address - Street 1:12 BARDWELL ST
Practice Address - Street 2:
Practice Address - City:JAMAICA PLAIN
Practice Address - State:MA
Practice Address - Zip Code:02130-3111
Practice Address - Country:US
Practice Address - Phone:617-680-9670
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-02
Last Update Date:2008-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1104031041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical