Provider Demographics
NPI:1104816156
Name:BREEN, JOAN C (MD)
Entity type:Individual
Prefix:
First Name:JOAN
Middle Name:C
Last Name:BREEN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:25 RAILROAD SQ
Mailing Address - Street 2:SUITE 503
Mailing Address - City:HAVERHILL
Mailing Address - State:MA
Mailing Address - Zip Code:01832-5721
Mailing Address - Country:US
Mailing Address - Phone:978-556-5907
Mailing Address - Fax:978-521-8818
Practice Address - Street 1:145 WARD HILL AVE
Practice Address - Street 2:WHITTIER REHABILITATION HOSPITAL
Practice Address - City:BRADFORD
Practice Address - State:MA
Practice Address - Zip Code:01835-6928
Practice Address - Country:US
Practice Address - Phone:978-372-8000
Practice Address - Fax:978-374-4423
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-21
Last Update Date:2010-03-02
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NH9011NH2084N0400X
MA759742084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH0101696Other0101696YONH01
NH30006121Medicaid
NH0101696Other0101696YONH01
RE2788Medicare ID - Type Unspecified