Provider Demographics
NPI:1639328719
Name:BRESNIHAN, JOHN MATTHEW
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:MATTHEW
Last Name:BRESNIHAN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:36 WORCESTER ST
Mailing Address - Street 2:
Mailing Address - City:BELMONT
Mailing Address - State:MA
Mailing Address - Zip Code:02478-3756
Mailing Address - Country:US
Mailing Address - Phone:781-799-4681
Mailing Address - Fax:
Practice Address - Street 1:130 BOYLSTON ST
Practice Address - Street 2:
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02216-0001
Practice Address - Country:US
Practice Address - Phone:617-457-8140
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-15
Last Update Date:2008-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical