Martin Brault, LADC

Individual provider Active NPI Addiction (Substance Use Disorder) Counselor · Wilton, CT

NPI 1922583236 · NPPES record last updated Oct 2, 2018

Key facts

NPI
1922583236
Entity type
Individual (NPI type 1)
Primary specialty
Addiction (Substance Use Disorder) Counselor 101YA0400X
License
000696 (CT)
Practice address
6 Hollyhock Rd FL 2
Wilton, CT 06897-4414
Phone
(203) 761-9487
Fax
(203) 761-9487
NPI assigned
Oct 2, 2018
Sex
Male
Sole proprietor
Yes

Medicare participation

Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

Medicare enrollment (NPD)
No

State licenses

LicenseStateTypeSpecialty
000696CTMDMarriage & Family Therapist

Specialties & licenses

Specialty (taxonomy)CodeLicenseStatePrimary
Addiction (Substance Use Disorder) Counselor
Group: 193400000X SINGLE SPECIALTY GROUP
101YA0400X 000696 CT Yes

Addresses

Primary practice location

6 Hollyhock Rd FL 2
Wilton, CT 06897-4414

Mailing address

6 Hollyhock Rd FL 2
Wilton, CT 06897-4414
Phone (203) 761-9487

Other providers in Wilton, CT

All providers in Wilton, CT · Addiction (Substance Use Disorder) Counselor in Connecticut

Sources for this page

Verify at the official NPI Registry.