Provider Demographics
NPI:1083714067
Name:DRENA, RICHARD E (MSLADC)
Entity Type:Individual
Prefix:MR
First Name:RICHARD
Middle Name:E
Last Name:DRENA
Suffix:
Gender:M
Credentials:MSLADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 766
Mailing Address - Street 2:
Mailing Address - City:WILLIMANTIC
Mailing Address - State:CT
Mailing Address - Zip Code:06226
Mailing Address - Country:US
Mailing Address - Phone:860-859-3169
Mailing Address - Fax:860-859-3919
Practice Address - Street 1:#72 RT 32
Practice Address - Street 2:
Practice Address - City:NORTH FRANKLIN
Practice Address - State:CT
Practice Address - Zip Code:06254
Practice Address - Country:US
Practice Address - Phone:860-859-3169
Practice Address - Fax:860-859-3169
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-22
Last Update Date:2007-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT000095CT101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)