Provider Demographics
NPI:1386881795
Name:FAVREAU, DAVID L (LMHC, LADC I)
Entity type:Individual
Prefix:MR
First Name:DAVID
Middle Name:L
Last Name:FAVREAU
Suffix:
Gender:M
Credentials:LMHC, LADC I
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 8895
Mailing Address - Street 2:
Mailing Address - City:LOWELL
Mailing Address - State:MA
Mailing Address - Zip Code:01853-8895
Mailing Address - Country:US
Mailing Address - Phone:978-957-5811
Mailing Address - Fax:978-957-5811
Practice Address - Street 1:33 KEARNEY SQUARE
Practice Address - Street 2:ANGER MANAGEMENT PROGRAM
Practice Address - City:LOWELL
Practice Address - State:MA
Practice Address - Zip Code:01852-1901
Practice Address - Country:US
Practice Address - Phone:978-957-5811
Practice Address - Fax:978-957-5811
Is Sole Proprietor?:Yes
Enumeration Date:2009-01-08
Last Update Date:2015-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA16101Y00000X
MA83101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)