Individual
RONALD L BREAZEALE
Active
Sole proprietor
Provider details
NPI number
Gender
Man
Credential
PH.D
Contact information
Practice address
205 OCEAN AVE, PORTLAND, ME 04103-5742
(207) 775-1335
Mailing address
205 OCEAN AVE, PORTLAND, ME 04103-5742
(207) 775-1335
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
Primary
PS305
ME
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
003573
BC/BS
ME
05
—
2336400000
—
ME
Enumeration date
06/14/2006
Last updated
07/09/2007
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