MEDICARE: JADIRA ELOISE BREAULT LPC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YP2500X	Professional Counselor	9572	CT

General Provider Information

NPI Number	:	1679179576
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JADIRA ELOISE BREAULT LPC

Provider Business Mailing Address
First Line	:	72 ROUTE 32
Second Line	:
City	:	NORTH FRANKLIN
State	:	CT
Zip	:	06254-1837
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	72 ROUTE 32
Second Line	:
City	:	NORTH FRANKLIN
State	:	CT
Zip	:	06254-1837
Country	:	US
Telephone Number	:	860-822-6009
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/07/2020
Last Update Date	:	05/20/2026

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