Doctor Name: | MS. CARRIE DALI BREAULT |
NPI Number: | 1205123924 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | MS |
License Number: | |
Business Practice Address: | 2917 13th St W Apt/suite Lehigh Acres, FL - 339715403 |
Business Phone Number: | 2398519625 |
Business Fax Number: | |
Mailing Address: | 2917 13th St W, LEHIGH ACRES |
State: | FL |
Postal Code: | 339715403 |
Phone Number: | 2393693988 |
Fax Number: | |
NPI Enumeration Date: | 07/01/2011 |
NPI Last Update Date: | 07/08/2013 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 101YM0800X |
License Number: | |
Healthcare Provider Taxonomy: (Secondary) | N |
State: | |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Counselor |
Taxonomy Specialization: | Mental Health |
Taxonomy Definition: |