Provider Demographics
NPI:1891332524
Name:BREAULT, PEGGY LEE (CADC)
Entity Type:Individual
Prefix:
First Name:PEGGY
Middle Name:LEE
Last Name:BREAULT
Suffix:
Gender:F
Credentials:CADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:56 BRADFORD LN
Mailing Address - Street 2:
Mailing Address - City:SOUTH CHINA
Mailing Address - State:ME
Mailing Address - Zip Code:04358-5038
Mailing Address - Country:US
Mailing Address - Phone:207-592-3558
Mailing Address - Fax:
Practice Address - Street 1:841 RIVERSIDE DR
Practice Address - Street 2:
Practice Address - City:AUGUSTA
Practice Address - State:ME
Practice Address - Zip Code:04330-8302
Practice Address - Country:US
Practice Address - Phone:844-294-5306
Practice Address - Fax:844-294-5306
Is Sole Proprietor?:No
Enumeration Date:2019-12-02
Last Update Date:2019-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MECAC7055101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)