| NPI | 1700424215 |
|---|---|
| Former Name | NICOLE ANN BREAULT |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: CT 11950) |
| Additional Taxonomies | 104100000X Social Worker (Licence: CT 4884) |
| Enumeration Date | 2019-12-16 |
| Last Update Date | 2022-03-17 |