Provider Demographics
NPI:1780783928
Name:DUBREUIL, SANDRA MARIA (LICSW, CADC)
Entity type:Individual
Prefix:
First Name:SANDRA
Middle Name:MARIA
Last Name:DUBREUIL
Suffix:
Gender:F
Credentials:LICSW, CADC
Other - Prefix:
Other - First Name:SANDRA
Other - Middle Name:MARIA
Other - Last Name:MATIAS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:386 STANLEY ST
Mailing Address - Street 2:
Mailing Address - City:FALL RIVER
Mailing Address - State:MA
Mailing Address - Zip Code:02720-6009
Mailing Address - Country:US
Mailing Address - Phone:508-679-5222
Mailing Address - Fax:508-673-3182
Practice Address - Street 1:386 STANLEY ST
Practice Address - Street 2:
Practice Address - City:FALL RIVER
Practice Address - State:MA
Practice Address - Zip Code:02720-6009
Practice Address - Country:US
Practice Address - Phone:508-679-5222
Practice Address - Fax:508-673-3182
Is Sole Proprietor?:No
Enumeration Date:2006-09-22
Last Update Date:2020-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1121991041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA31002OtherBMC HEALTHNET
MA1039880OtherBEACON HEALTH STRATEGIES
MA31002OtherBMC HEALTHNET