Provider Demographics
NPI:1649724824
Name:BARRIE DAIGNEAULT LICSW LLC
Entity type:Organization
Organization Name:BARRIE DAIGNEAULT LICSW LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICIAN
Authorized Official - Prefix:
Authorized Official - First Name:BARRIE
Authorized Official - Middle Name:
Authorized Official - Last Name:DAIGNEAULT
Authorized Official - Suffix:
Authorized Official - Credentials:LICSW
Authorized Official - Phone:603-867-2974
Mailing Address - Street 1:53 MAMMOTH RD
Mailing Address - Street 2:
Mailing Address - City:MANCHESTER
Mailing Address - State:NH
Mailing Address - Zip Code:03109-4301
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
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-08-05
Last Update Date:2016-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH8481041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH3086040Medicaid