Provider Demographics
NPI:1790859262
Name:BRANNAN, MICHELE M (LICENSED CLINICAL ME)
Entity Type:Individual
Prefix:MRS
First Name:MICHELE
Middle Name:M
Last Name:BRANNAN
Suffix:
Gender:F
Credentials:LICENSED CLINICAL ME
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 401
Mailing Address - Street 2:
Mailing Address - City:AMHERST
Mailing Address - State:NH
Mailing Address - Zip Code:03031
Mailing Address - Country:US
Mailing Address - Phone:603-472-8657
Mailing Address - Fax:603-672-4546
Practice Address - Street 1:360 RTE 101
Practice Address - Street 2:SUITE 10
Practice Address - City:BEDFORD
Practice Address - State:NH
Practice Address - Zip Code:03110
Practice Address - Country:US
Practice Address - Phone:603-472-8657
Practice Address - Fax:603-672-4546
Is Sole Proprietor?:No
Enumeration Date:2006-11-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH24101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
29370OtherNATIONAL BOARD OF CERTIFI
NH80009139Medicaid
NH24OtherBOARD OF PSYCHOLOGY & MEN