Active NPI
David Joseph Breault, LISW
- Clinical Social Worker
- Albuquerque, NM
National Provider Identifier
1104975960
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Social Worker
- License
- I-2244
- Practice address
- 3214 Purdue PL NE
Albuquerque, NM 87106-2124 - Phone
- (505) 266-9233
- Fax
- (505) 266-1440
- NPI assigned
- Jan 10, 2007
- Sex
- Male
- Sole proprietor
- Yes
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 | I-2244 | NM | Primary |
Addresses
Primary practice location
3214 Purdue PL NE
Albuquerque, NM 87106-2124
Mailing address
3214 Purdue PL NE
Albuquerque, NM 87106-2124
Phone (505) 266-9233
Other identifiers 5
| Identifier | Type | State | Issuer |
|---|---|---|---|
| NM100163 | Other | NM | VALUEOPTIONS |
| 00NM00R39Q | Other | NM | BLUECROSSBLUESHIELD |
| 260776 | Other | NM | COMPSYCH |
| 096959 | Other | NM | VALUEOPTIONS |
| 97446 | Medicaid | NM |
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 |
|---|---|---|---|
| I-2244 | NM | MD | Clinical Social Worker |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1168387200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183939200000",
"number": "1104975960",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3214 PURDUE PL NE",
"city": "ALBUQUERQUE",
"state": "NM",
"postal_code": "871062124",
"telephone_number": "505-266-9233",
"fax_number": "505-266-1440"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3214 PURDUE PL NE",
"city": "ALBUQUERQUE",
"state": "NM",
"postal_code": "871062124",
"telephone_number": "505-266-9233",
"fax_number": "505-266-1440"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BREAULT",
"first_name": "DAVID",
"middle_name": "JOSEPH",
"credential": "LISW",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2007-01-10",
"last_updated": "2007-07-09",
"status": "A"
},
"taxonomies": [
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "NM",
"license": "I-2244",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "VALUEOPTIONS",
"identifier": "NM100163",
"state": "NM"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BLUECROSSBLUESHIELD",
"identifier": "00NM00R39Q",
"state": "NM"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "COMPSYCH",
"identifier": "260776",
"state": "NM"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "VALUEOPTIONS",
"identifier": "096959",
"state": "NM"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "97446",
"state": "NM"
}
],
"endpoints": [],
"other_names": []
}Other providers in Albuquerque, NM
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 9, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.