Provider Demographics
NPI:1770471047
Name:GENDREAU, MERYL ASHLEY
Entity type:Individual
Prefix:
First Name:MERYL
Middle Name:ASHLEY
Last Name:GENDREAU
Suffix:
Gender:X
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1431 MAPLE VALLEY RD
Mailing Address - Street 2:
Mailing Address - City:GREENE
Mailing Address - State:RI
Mailing Address - Zip Code:02827-1628
Mailing Address - Country:US
Mailing Address - Phone:401-523-1614
Mailing Address - Fax:
Practice Address - Street 1:215 WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:WEST WARWICK
Practice Address - State:RI
Practice Address - Zip Code:02893-5176
Practice Address - Country:US
Practice Address - Phone:401-822-1360
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-06-25
Last Update Date:2025-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIMHC00321-A101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health