Provider Demographics
NPI:1679846968
Name:CRESSY, BRIAN GERALD (LADC)
Entity Type:Individual
Prefix:MR
First Name:BRIAN
Middle Name:GERALD
Last Name:CRESSY
Suffix:
Gender:M
Credentials:LADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2 VILLAGE GREEN RD
Mailing Address - Street 2:BLDG 2 SUITE B
Mailing Address - City:HAMPSTEAD
Mailing Address - State:NH
Mailing Address - Zip Code:03841-5209
Mailing Address - Country:US
Mailing Address - Phone:603-489-1177
Mailing Address - Fax:
Practice Address - Street 1:2 VILLAGE GREEN RD
Practice Address - Street 2:BLDG 2 SUITE B
Practice Address - City:HAMPSTEAD
Practice Address - State:NH
Practice Address - Zip Code:03841-5209
Practice Address - Country:US
Practice Address - Phone:603-489-1177
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-02-16
Last Update Date:2012-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH0485101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)