Provider Demographics
NPI:1225299340
Name:GENDREAU, RICHARD ALLEN (LMHC,LADC,CEAP,CADAC)
Entity Type:Individual
Prefix:MR
First Name:RICHARD
Middle Name:ALLEN
Last Name:GENDREAU
Suffix:
Gender:M
Credentials:LMHC,LADC,CEAP,CADAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:35 MAIN ST
Mailing Address - Street 2:SUITE B
Mailing Address - City:STURBRIDGE
Mailing Address - State:MA
Mailing Address - Zip Code:01566-1245
Mailing Address - Country:US
Mailing Address - Phone:508-347-5403
Mailing Address - Fax:413-245-6816
Practice Address - Street 1:35 MAIN ST
Practice Address - Street 2:SUITE B
Practice Address - City:STURBRIDGE
Practice Address - State:MA
Practice Address - Zip Code:01566-1245
Practice Address - Country:US
Practice Address - Phone:508-347-5403
Practice Address - Fax:413-245-6816
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-20
Last Update Date:2008-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA6609101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health