Provider Demographics
NPI:1114421054
Name:BRETANA, BRITNEY
Entity Type:Individual
Prefix:
First Name:BRITNEY
Middle Name:
Last Name:BRETANA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:225 NEWMAN AVE
Mailing Address - Street 2:
Mailing Address - City:RUMFORD
Mailing Address - State:RI
Mailing Address - Zip Code:02916-1218
Mailing Address - Country:US
Mailing Address - Phone:401-270-7110
Mailing Address - Fax:
Practice Address - Street 1:387 MAIN ST
Practice Address - Street 2:
Practice Address - City:OXFORD
Practice Address - State:MA
Practice Address - Zip Code:01540-1780
Practice Address - Country:US
Practice Address - Phone:508-987-4211
Practice Address - Fax:774-221-9010
Is Sole Proprietor?:No
Enumeration Date:2018-03-23
Last Update Date:2022-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
106S00000X
MA4134103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician