Provider Demographics
NPI:1457143448
Name:DUVERGER, BREANNA MARIE
Entity type:Individual
Prefix:
First Name:BREANNA
Middle Name:MARIE
Last Name:DUVERGER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15 CARMEL ST
Mailing Address - Street 2:
Mailing Address - City:HARTFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06106-4206
Mailing Address - Country:US
Mailing Address - Phone:860-953-7604
Mailing Address - Fax:
Practice Address - Street 1:15 CARMEL ST
Practice Address - Street 2:
Practice Address - City:HARTFORD
Practice Address - State:CT
Practice Address - Zip Code:06106-4206
Practice Address - Country:US
Practice Address - Phone:860-221-8841
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-05-19
Last Update Date:2025-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician