Provider Demographics
NPI:1588006274
Name:CHEVALIER, BREANNA MAY (LCPC-C)
Entity Type:Individual
Prefix:
First Name:BREANNA
Middle Name:MAY
Last Name:CHEVALIER
Suffix:
Gender:F
Credentials:LCPC-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:500 US ROUTE 1
Mailing Address - Street 2:SUITE 102
Mailing Address - City:YARMOUTH
Mailing Address - State:ME
Mailing Address - Zip Code:04096-6816
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:500 US ROUTE 1
Practice Address - Street 2:SUITE 102
Practice Address - City:YARMOUTH
Practice Address - State:ME
Practice Address - Zip Code:04096-6816
Practice Address - Country:US
Practice Address - Phone:207-847-2273
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-07-23
Last Update Date:2013-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEXL4171101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health