Provider Demographics
NPI:1730281742
Name:BRILL, JACQUELINE (MA)
Entity Type:Individual
Prefix:
First Name:JACQUELINE
Middle Name:
Last Name:BRILL
Suffix:
Gender:F
Credentials:MA
Other - Prefix:MRS
Other - First Name:JACQUELINE
Other - Middle Name:
Other - Last Name:LAFLEUR
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:1 COURT ST
Mailing Address - Street 2:SUITE 220
Mailing Address - City:LEBANON
Mailing Address - State:NH
Mailing Address - Zip Code:03766-1358
Mailing Address - Country:US
Mailing Address - Phone:603-448-1988
Mailing Address - Fax:603-448-1988
Practice Address - Street 1:1 COURT ST
Practice Address - Street 2:SUITE 220
Practice Address - City:LEBANON
Practice Address - State:NH
Practice Address - Zip Code:03766-1358
Practice Address - Country:US
Practice Address - Phone:603-448-1988
Practice Address - Fax:603-448-1988
Is Sole Proprietor?:No
Enumeration Date:2006-09-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH278101YA0400X
NH67101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Not Answered101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT1008001Medicaid
NH30011384Medicaid