Healthcare Provider Details

I. General information

NPI: 1841933769
Provider Name (Legal Business Name): BRIANA POLVERE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/18/2022
Last Update Date: 01/05/2026
Certification Date: 04/18/2022
Deactivation Date: 10/04/2024
Reactivation Date: 01/05/2026

III. Provider practice location address

180 MAIN ST APT E103
BRIDGEWATER MA
02324-1564
US

IV. Provider business mailing address

180 MAIN ST APT E103
BRIDGEWATER MA
02324-1564
US

V. Phone/Fax

Practice location:
  • Phone: 508-245-3503
  • Fax:
Mailing address:
  • Phone: 508-245-3503
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: