Provider Demographics
NPI:1427388412
Name:HRANAC, IVYSUE (MSW)
Entity Type:Individual
Prefix:MS
First Name:IVYSUE
Middle Name:
Last Name:HRANAC
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:MRS
Other - First Name:IVYSUE
Other - Middle Name:
Other - Last Name:RICHARDSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW
Mailing Address - Street 1:60 HANSON ST UNIT 2
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NH
Mailing Address - Zip Code:03867-2720
Mailing Address - Country:US
Mailing Address - Phone:603-750-3246
Mailing Address - Fax:
Practice Address - Street 1:60 HANSON ST UNIT 2
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NH
Practice Address - Zip Code:03867-2720
Practice Address - Country:US
Practice Address - Phone:603-750-3246
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-01-13
Last Update Date:2023-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACG60829279101Y00000X
NH29221041C0700X
NH19231041C0700X
WALW608427361041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA2114202Medicaid