MEDICARE: KRISTEN LAURA VERDEAUX CDAC, LADCII

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YA0400X	Addiction (Substance Use Disorder) Counselor	2162	MA

General Provider Information

NPI Number	:	1598084360
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KRISTEN LAURA VERDEAUX CDAC, LADCII

Provider Business Mailing Address
First Line	:	120 FOXBORO AVE
Second Line	:
City	:	PORTSMOUTH
State	:	RI
Zip	:	02871-5523
Country	:	US
Telephone Number	:	401-486-6947
Fax Number	:

Provider Business Practice Location Address
First Line	:	108 N FRONT ST
Second Line	:	WATC - ATS
City	:	NEW BEDFORD
State	:	MA
Zip	:	02740-7327
Country	:	US
Telephone Number	:	774-628-1000
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/19/2010
Last Update Date	:	12/26/2014

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