Healthcare Provider Details

I. General information

NPI: 1083714067
Provider Name (Legal Business Name): RICHARD E DRENA MSLADC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/22/2006
Last Update Date: 11/16/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

#72 RT 32
NORTH FRANKLIN CT
06254
US

IV. Provider business mailing address

PO BOX 766
WILLIMANTIC CT
06226
US

V. Phone/Fax

Practice location:
  • Phone: 860-859-3169
  • Fax: 860-859-3169
Mailing address:
  • Phone: 860-859-3169
  • Fax: 860-859-3919

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number000095CT
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: