Provider Demographics
NPI:1265213029
Name:BREAULT, CHANTAL L
Entity type:Individual
Prefix:
First Name:CHANTAL
Middle Name:L
Last Name:BREAULT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 CROWN ST
Mailing Address - Street 2:
Mailing Address - City:WESTFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01085-1111
Mailing Address - Country:US
Mailing Address - Phone:413-575-0652
Mailing Address - Fax:
Practice Address - Street 1:318 MONUMENT VALLEY RD
Practice Address - Street 2:
Practice Address - City:GREAT BARRINGTON
Practice Address - State:MA
Practice Address - Zip Code:01230-1469
Practice Address - Country:US
Practice Address - Phone:413-575-0652
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-10-09
Last Update Date:2023-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician