Provider Demographics
NPI:1336688308
Name:DUBREUIL, AMY
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:
Last Name:DUBREUIL
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 1:134 BRIDGE ST
Mailing Address - Street 2:
Mailing Address - City:FAIRHAVEN
Mailing Address - State:MA
Mailing Address - Zip Code:02719-4128
Mailing Address - Country:US
Mailing Address - Phone:508-415-2756
Mailing Address - Fax:
Practice Address - Street 1:134 BRIDGE ST
Practice Address - Street 2:
Practice Address - City:FAIRHAVEN
Practice Address - State:MA
Practice Address - Zip Code:02719-4128
Practice Address - Country:US
Practice Address - Phone:508-415-2756
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-02-23
Last Update Date:2017-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health