MEDICARE: TAYLOR LEBRECK BRUNEAU

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	101YM0800X	Mental Health Counselor

General Provider Information

NPI Number	:	1710815824
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TAYLOR LEBRECK BRUNEAU

Provider Business Mailing Address
First Line	:	305 SALEM ST
Second Line	:
City	:	HAVERHILL
State	:	MA
Zip	:	01835-7622
Country	:	US
Telephone Number	:	978-971-2659
Fax Number	:

Provider Business Practice Location Address
First Line	:	360 MERRIMACK ST
Second Line	:
City	:	LAWRENCE
State	:	MA
Zip	:	01843-1740
Country	:	US
Telephone Number	:	978-989-9897
Fax Number	:

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

Provider Enumeration Date	:	05/11/2026
Last Update Date	:	05/11/2026

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