Individual
DAVID JOSEPH BREAULT
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
LISW
Contact information
Practice address
3214 PURDUE PL NE, ALBUQUERQUE, NM 87106-2124
(505) 266-9233
(505) 266-1440
Mailing address
3214 PURDUE PL NE, ALBUQUERQUE, NM 87106-2124
(505) 266-9233
(505) 266-1440
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
I-2244
NM
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
00NM00R39Q
BLUECROSSBLUESHIELD
NM
01
—
096959
VALUEOPTIONS
NM
01
—
260776
COMPSYCH
NM
05
—
97446
—
NM
01
—
NM100163
VALUEOPTIONS
NM
Enumeration date
01/10/2007
Last updated
07/09/2007
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