Provider Demographics
NPI:1134964281
Name:REA, BREANNA (LMHC-A)
Entity type:Individual
Prefix:
First Name:BREANNA
Middle Name:
Last Name:REA
Suffix:
Gender:F
Credentials:LMHC-A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2 COUNTRY DR
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:RI
Mailing Address - Zip Code:02828-1902
Mailing Address - Country:US
Mailing Address - Phone:401-330-0916
Mailing Address - Fax:
Practice Address - Street 1:3296 POST RD # 2A
Practice Address - Street 2:
Practice Address - City:WARWICK
Practice Address - State:RI
Practice Address - Zip Code:02886-7131
Practice Address - Country:US
Practice Address - Phone:401-739-1010
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-06-29
Last Update Date:2024-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIMHC00209101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health