Provider Demographics
NPI:1598084360
Name:VERDEAUX, KRISTEN LAURA (CDAC, LADCII)
Entity Type:Individual
Prefix:
First Name:KRISTEN
Middle Name:LAURA
Last Name:VERDEAUX
Suffix:
Gender:F
Credentials:CDAC, LADCII
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:120 FOXBORO AVE
Mailing Address - Street 2:
Mailing Address - City:PORTSMOUTH
Mailing Address - State:RI
Mailing Address - Zip Code:02871-5523
Mailing Address - Country:US
Mailing Address - Phone:401-486-6947
Mailing Address - Fax:
Practice Address - Street 1:108 N FRONT ST
Practice Address - Street 2:WATC - ATS
Practice Address - City:NEW BEDFORD
Practice Address - State:MA
Practice Address - Zip Code:02740-7327
Practice Address - Country:US
Practice Address - Phone:774-628-1000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-05-19
Last Update Date:2014-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2162101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)