Healthcare Provider Details

I. General information

NPI: 1598084360
Provider Name (Legal Business Name): KRISTEN LAURA VERDEAUX CDAC, LADCII
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/19/2010
Last Update Date: 12/26/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

108 N FRONT ST WATC - ATS
NEW BEDFORD MA
02740-7327
US

IV. Provider business mailing address

120 FOXBORO AVE
PORTSMOUTH RI
02871-5523
US

V. Phone/Fax

Practice location:
  • Phone: 774-628-1000
  • Fax:
Mailing address:
  • Phone: 401-486-6947
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number2162
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: