Provider Demographics
NPI:1740330232
Name:RESNICOFF, HARRIET G (LICSW)
Entity type:Individual
Prefix:MS
First Name:HARRIET
Middle Name:G
Last Name:RESNICOFF
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:MS
Other - First Name:HARRIET
Other - Middle Name:A
Other - Last Name:GELLMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LICSW
Mailing Address - Street 1:85 WARREN ST
Mailing Address - Street 2:
Mailing Address - City:CONCORD
Mailing Address - State:NH
Mailing Address - Zip Code:03301-3837
Mailing Address - Country:US
Mailing Address - Phone:603-228-1090
Mailing Address - Fax:603-228-6018
Practice Address - Street 1:85 WARREN ST
Practice Address - Street 2:
Practice Address - City:CONCORD
Practice Address - State:NH
Practice Address - Zip Code:03301-3837
Practice Address - Country:US
Practice Address - Phone:603-224-2841
Practice Address - Fax:603-228-6018
Is Sole Proprietor?:No
Enumeration Date:2007-01-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NHNH405101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH30007368Medicaid
NHRESN686481OtherANTHEM BLUE CROSS
NHRESN686481OtherANTHEM BLUE CROSS