Provider Demographics
NPI:1235423922
Name:PERREAULT, TRICIA L (MHRT-C)
Entity Type:Individual
Prefix:
First Name:TRICIA
Middle Name:L
Last Name:PERREAULT
Suffix:
Gender:F
Credentials:MHRT-C
Other - Prefix:
Other - First Name:TRICIA
Other - Middle Name:
Other - Last Name:CAIRNS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MHRT-C
Mailing Address - Street 1:88 FOX ST
Mailing Address - Street 2:SUITE 101
Mailing Address - City:MADAWASKA
Mailing Address - State:ME
Mailing Address - Zip Code:04756-1352
Mailing Address - Country:US
Mailing Address - Phone:207-728-6341
Mailing Address - Fax:207-728-7762
Practice Address - Street 1:88 FOX ST
Practice Address - Street 2:SUITE 101
Practice Address - City:MADAWASKA
Practice Address - State:ME
Practice Address - Zip Code:04756
Practice Address - Country:US
Practice Address - Phone:207-728-6341
Practice Address - Fax:207-728-7762
Is Sole Proprietor?:No
Enumeration Date:2011-05-31
Last Update Date:2018-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME103850000Medicaid