Healthcare Provider Details

I. General information

NPI: 1710815824
Provider Name (Legal Business Name): TAYLOR LEBRECK BRUNEAU
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/11/2026
Last Update Date: 05/11/2026
Certification Date: 05/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

360 MERRIMACK ST
LAWRENCE MA
01843-1740
US

IV. Provider business mailing address

305 SALEM ST
HAVERHILL MA
01835-7622
US

V. Phone/Fax

Practice location:
  • Phone: 978-989-9897
  • Fax:
Mailing address:
  • Phone: 978-971-2659
  • 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: