| Doctor Name: | MR. RICHARD ALLEN GENDREAU |
| NPI Number: | 1225299340 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | LMHC,LADC,CEAP,CADAC |
| License Number: | 6609 |
| Business Practice Address: | 35 Main St Suite B Sturbridge, MA - 015661245 |
| Business Phone Number: | 5083475403 |
| Business Fax Number: | 4132456816 |
| Mailing Address: | 35 Main St, Suite B STURBRIDGE |
| State: | MA |
| Postal Code: | 015661245 |
| Phone Number: | 5083475403 |
| Fax Number: | 4132456816 |
| NPI Enumeration Date: | 06/20/2008 |
| NPI Last Update Date: | 06/20/2008 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 101YM0800X |
| License Number: | 6609 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | MA |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Counselor |
| Taxonomy Specialization: | Mental Health |
| Taxonomy Definition: | |