Provider Demographics
NPI:1174590921
Name:DAIGNEAULT, JUNE (LICSW)
Entity type:Individual
Prefix:
First Name:JUNE
Middle Name:
Last Name:DAIGNEAULT
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 OLD DOVER RD
Mailing Address - Street 2:SUITE 1
Mailing Address - City:ROCHESTER
Mailing Address - State:NH
Mailing Address - Zip Code:03867-3460
Mailing Address - Country:US
Mailing Address - Phone:603-335-2444
Mailing Address - Fax:603-335-2226
Practice Address - Street 1:660 CENTRAL AVE
Practice Address - Street 2:SUITE 201
Practice Address - City:DOVER
Practice Address - State:NH
Practice Address - Zip Code:03820-3491
Practice Address - Country:US
Practice Address - Phone:603-743-2223
Practice Address - Fax:603-749-3365
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH2961041C0700X
MELC16861041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH1403851Y0NH01OtherANTHEM
NH30420161Medicaid
NH1403851Y0NH01OtherANTHEM
NH30420161Medicaid