Healthcare Provider Details

I. General information

NPI: 1063531424
Provider Name (Legal Business Name): JOSE RAFAEL ABREU BA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/28/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

650 SUFFOLK ST
LOWELL MA
01854-3642
US

IV. Provider business mailing address

PO BOX 141
METHUEN MA
01844-0141
US

V. Phone/Fax

Practice location:
  • Phone: 978-452-5155
  • Fax:
Mailing address:
  • Phone: 978-689-5638
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: