Active NPI
Richard Breault, LICSW
- Clinical Social Worker
- Worcester, MA
National Provider Identifier
1104204619
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Social Worker
- License
- 1017552
- Practice address
- 50 Elm St
Suite 3B
Worcester, MA 01609-2574 - Phone
- (508) 755-0436
- NPI assigned
- May 16, 2015
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Social Worker | 1041C0700X | 1017552 | MA | Primary |
Addresses
Primary practice location
50 Elm St
Suite 3B
Worcester, MA 01609-2574
Mailing address
50 Elm St
Suite 3B
Worcester, MA 01609-2574
Phone (508) 755-0436
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 1017552 | MA | MD | Clinical Social Worker |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1431734400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1431734400000",
"number": "1104204619",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "50 ELM ST",
"address_2": "SUITE 3B",
"city": "WORCESTER",
"state": "MA",
"postal_code": "016092574",
"telephone_number": "508-755-0436"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "50 ELM ST",
"address_2": "SUITE 3B",
"city": "WORCESTER",
"state": "MA",
"postal_code": "016092574",
"telephone_number": "508-755-0436"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BREAULT",
"first_name": "RICHARD",
"credential": "LICSW",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2015-05-16",
"last_updated": "2015-05-16",
"status": "A"
},
"taxonomies": [
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "MA",
"license": "1017552",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Worcester, MA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 16, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.