Provider Demographics
NPI:1447425277
Name:PERREAULT, ANDRE (MA)
Entity Type:Individual
Prefix:
First Name:ANDRE
Middle Name:
Last Name:PERREAULT
Suffix:
Gender:M
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:288 WALNUT ST STE 380
Mailing Address - Street 2:
Mailing Address - City:NEWTON
Mailing Address - State:MA
Mailing Address - Zip Code:02460-1994
Mailing Address - Country:US
Mailing Address - Phone:617-326-8404
Mailing Address - Fax:617-326-8420
Practice Address - Street 1:288 WALNUT ST STE 380
Practice Address - Street 2:
Practice Address - City:NEWTON
Practice Address - State:MA
Practice Address - Zip Code:02460-1994
Practice Address - Country:US
Practice Address - Phone:617-326-8404
Practice Address - Fax:617-326-8420
Is Sole Proprietor?:No
Enumeration Date:2008-04-23
Last Update Date:2019-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA7189101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health