Provider Demographics
NPI:1508301284
Name:LEBRETON, JAYLEE
Entity Type:Individual
Prefix:
First Name:JAYLEE
Middle Name:
Last Name:LEBRETON
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 1:119 KING AVE
Mailing Address - Street 2:UNIT F
Mailing Address - City:WEYMOUTH
Mailing Address - State:MA
Mailing Address - Zip Code:02188-2957
Mailing Address - Country:US
Mailing Address - Phone:617-257-5956
Mailing Address - Fax:
Practice Address - Street 1:119 KING AVENUE
Practice Address - Street 2:UNIT F
Practice Address - City:WEYMOUTH
Practice Address - State:MA
Practice Address - Zip Code:02188
Practice Address - Country:US
Practice Address - Phone:617-257-5956
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-01-04
Last Update Date:2017-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program