Basic Information
| Provider Information | |||||||||
| NPI: | 1154987303 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | SHRIVER HALLIGAN | ||||||||
| FirstName: | JOHANNA | ||||||||
| MiddleName: | ELISE | ||||||||
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| Credential: | MT-BC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 17 BIRCH HILL RD | ||||||||
| Address2: | |||||||||
| City: | BROOKLINE | ||||||||
| State: | NH | ||||||||
| PostalCode: | 030332451 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6177779297 | ||||||||
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| Practice Location | |||||||||
| Address1: | 289 GREAT RD | ||||||||
| Address2: | |||||||||
| City: | ACTON | ||||||||
| State: | MA | ||||||||
| PostalCode: | 017204766 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9786791200 | ||||||||
| FaxNumber: | 9784864037 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/14/2019 | ||||||||
| LastUpdateDate: | 05/14/2019 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101Y00000X | Y | Behavioral Health & Social Service Providers | Counselor |
No ID Information.