Provider Demographics
NPI:1629300801
Name:BREAU, LAUREN (LAC, MACOM)
Entity Type:Individual
Prefix:
First Name:LAUREN
Middle Name:
Last Name:BREAU
Suffix:
Gender:F
Credentials:LAC, MACOM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:67 ATLANTIC AVE
Mailing Address - Street 2:
Mailing Address - City:SOUTH PORTLAND
Mailing Address - State:ME
Mailing Address - Zip Code:04106-2702
Mailing Address - Country:US
Mailing Address - Phone:503-550-6375
Mailing Address - Fax:
Practice Address - Street 1:1 BRICKYARD LN STE E
Practice Address - Street 2:
Practice Address - City:YORK
Practice Address - State:ME
Practice Address - Zip Code:03909-1687
Practice Address - Country:US
Practice Address - Phone:503-445-8114
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-02-12
Last Update Date:2011-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEAC 369171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist