Basic Information
| Provider Information | |||||||||
| NPI: | 1750318846 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | GENDREAU | ||||||||
| FirstName: | JANINE | ||||||||
| MiddleName: | V | ||||||||
| NamePrefix: | MS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MA, LMHC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 63 LEE ST | ||||||||
| Address2: | |||||||||
| City: | FALL RIVER | ||||||||
| State: | MA | ||||||||
| PostalCode: | 027242825 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5086747797 | ||||||||
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| Practice Location | |||||||||
| Address1: | 10 N MAIN ST | ||||||||
| Address2: | |||||||||
| City: | FALL RIVER | ||||||||
| State: | MA | ||||||||
| PostalCode: | 027202130 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5086782833 | ||||||||
| FaxNumber: | 5086759640 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/26/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YM0800X | 1281 | MA | Y | Behavioral Health & Social Service Providers | Counselor | Mental Health |
No ID Information.