Provider Demographics
NPI:1780572974
Name:BERROUET, LEE
Entity type:Individual
Prefix:
First Name:LEE
Middle Name:
Last Name:BERROUET
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:56 W MOUNTAIN ST
Mailing Address - Street 2:
Mailing Address - City:WORCESTER
Mailing Address - State:MA
Mailing Address - Zip Code:01606-1340
Mailing Address - Country:US
Mailing Address - Phone:781-492-6982
Mailing Address - Fax:
Practice Address - Street 1:56 W MOUNTAIN ST
Practice Address - Street 2:
Practice Address - City:WORCESTER
Practice Address - State:MA
Practice Address - Zip Code:01606-1340
Practice Address - Country:US
Practice Address - Phone:781-492-6982
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 Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician