Provider Demographics
NPI:1952381964
Name:BRAGG, JANET B (LICSW , LADC)
Entity Type:Individual
Prefix:
First Name:JANET
Middle Name:B
Last Name:BRAGG
Suffix:
Gender:F
Credentials:LICSW , LADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:33 ROBIN ACRES DR
Mailing Address - Street 2:
Mailing Address - City:WOLFEBORO
Mailing Address - State:NH
Mailing Address - Zip Code:03894-4319
Mailing Address - Country:US
Mailing Address - Phone:603-569-9350
Mailing Address - Fax:603-742-6069
Practice Address - Street 1:251 CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:DOVER
Practice Address - State:NH
Practice Address - Zip Code:03820-4126
Practice Address - Country:US
Practice Address - Phone:603-742-0566
Practice Address - Fax:603-742-6069
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-18
Last Update Date:2013-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH5371041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH1406303YONH03OtherANTHEM BC-BS
NH30423524Medicaid
NHRE6779Medicare ID - Type Unspecified