Individual
DR. MARY BRAGG BALLOU
Active
Sole proprietor
Provider details
NPI number
Gender
F
Credential
PHD
Contact information
Practice address
69C ISLAND ST, KEENE, NH 03431-3529
(603) 354-6700
Mailing address
69C ISLAND ST, KEENE, NH 03431-3529
(603) 354-6700
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
Primary
299
NH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
299
LICENSE
NH
Enumeration date
01/02/2006
Last updated
07/08/2007
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