Individual
MARLENA-RAY BREAULT
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LCDP,ACDP
Contact information
Practice address
830 CHALKSTONE AVE, PROVIDENCE, RI 02908-4734
(401) 273-7100
(401) 525-2586
Mailing address
117 ELLENFIELD ST STE 101, PROVIDENCE, RI 02905-4541
(401) 444-6779
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
CDP00601
RI
1041C0700X
Clinical Social Worker
Primary
ISW03485
RI
Other
Enumeration date
01/14/2015
Last updated
08/05/2025
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