Provider Demographics
NPI:1316242076
Name:MCBREAIRTY, REBECCA A (LADC)
Entity type:Individual
Prefix:
First Name:REBECCA
Middle Name:A
Last Name:MCBREAIRTY
Suffix:
Gender:F
Credentials:LADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:180 ACADEMY ST STE 3
Mailing Address - Street 2:
Mailing Address - City:PRESQUE ISLE
Mailing Address - State:ME
Mailing Address - Zip Code:04769-3183
Mailing Address - Country:US
Mailing Address - Phone:207-554-2352
Mailing Address - Fax:207-554-2351
Practice Address - Street 1:382 MAIN ST
Practice Address - Street 2:
Practice Address - City:LIMESTONE
Practice Address - State:ME
Practice Address - Zip Code:04750-6607
Practice Address - Country:US
Practice Address - Phone:207-325-4727
Practice Address - Fax:207-325-4308
Is Sole Proprietor?:No
Enumeration Date:2011-01-11
Last Update Date:2021-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MELC6063101YA0400X, 101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME103850000Medicaid