Provider Demographics
NPI:1659380251
Name:DAIGNEAULT, BARRIE ANN (LICSW)
Entity Type:Individual
Prefix:MRS
First Name:BARRIE
Middle Name:ANN
Last Name:DAIGNEAULT
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:53 MAMMOTH RD.
Mailing Address - Street 2:FAITH BAPTIST CHURCH
Mailing Address - City:MANCHESTER
Mailing Address - State:NH
Mailing Address - Zip Code:03109
Mailing Address - Country:US
Mailing Address - Phone:603-867-2974
Mailing Address - Fax:603-666-7177
Practice Address - Street 1:53 MAMMOTH RD
Practice Address - Street 2:
Practice Address - City:MANCHESTER
Practice Address - State:NH
Practice Address - Zip Code:03109-4301
Practice Address - Country:US
Practice Address - Phone:603-867-2974
Practice Address - Fax:603-666-7177
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH#848101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
0007090277OtherAETNA
NV112382OtherBHN INDEMNITY
NH550010007637OtherPACIFIC HEALTH CARE
NH24384400OtherMAGELLAN
NV112382OtherBHN INDEMNITY