Doctor Name: | MARLENA-RAY BREAULT |
NPI Number: | 1144619172 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | LCDP,ACDP |
License Number: | CDP00601 |
Business Practice Address: | 1950 Tower Hill Rd North Kingstown, RI - 028526639 |
Business Phone Number: | 4012357000 |
Business Fax Number: | |
Mailing Address: | Po Box 1700, WOONSOCKET |
State: | RI |
Postal Code: | 028950856 |
Phone Number: | 4012357000 |
Fax Number: | |
NPI Enumeration Date: | 01/14/2015 |
NPI Last Update Date: | 01/14/2015 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 101YA0400X |
License Number: | CDP00601 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | RI |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Counselor |
Taxonomy Specialization: | Addiction (Substance Use Disorder) |
Taxonomy Definition: |