Provider Demographics
NPI:1962719674
Name:BREEN, ABIGAIL SUE (LADC)
Entity type:Individual
Prefix:MS
First Name:ABIGAIL
Middle Name:SUE
Last Name:BREEN
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:PO BOX 235
Mailing Address - Street 2:
Mailing Address - City:SOUTH STRAFFORD
Mailing Address - State:VT
Mailing Address - Zip Code:05070-0235
Mailing Address - Country:US
Mailing Address - Phone:802-377-5796
Mailing Address - Fax:
Practice Address - Street 1:4 N MAIN ST
Practice Address - Street 2:
Practice Address - City:WHITE RIVER JUNCTION
Practice Address - State:VT
Practice Address - Zip Code:05001-7062
Practice Address - Country:US
Practice Address - Phone:802-377-5796
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-02
Last Update Date:2010-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT000491101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)