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General NPI Number Information
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NPI Number | 1598084360
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Entity Type | Individual
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Provider Name | KRISTEN LAURA VERDEAUX CDAC, LADCII
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Gender | Female
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Dates
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Enumeration Date | 05/19/2010
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Last Update Date | 12/26/2014
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Provider Practice Location Address
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Address Line | 108 N FRONT ST WATC - ATS
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City | NEW BEDFORD
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State | MA
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Zip | 02740-7327
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Country | US
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Telephone | 774-628-1000
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Fax |
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Provider Business Mailing Address
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Address Line | 120 FOXBORO AVE
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City | PORTSMOUTH
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State | RI
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Zip | 02871-5523
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Country | US
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Telephone | 401-486-6947
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | 2162
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License Number State | MA
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