1295189074 NPI number — MR. NORMAND ROBERT BRISSETTE CADC, LCDP

Table of content: MR. NORMAND ROBERT BRISSETTE CADC, LCDP (NPI 1295189074)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1295189074 NPI number — MR. NORMAND ROBERT BRISSETTE CADC, LCDP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BRISSETTE
Provider First Name:
NORMAND
Provider Middle Name:
ROBERT
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
Provider Credential Text:
CADC, LCDP
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1295189074
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/10/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
154 WATERMAN ST.
Provider Second Line Business Mailing Address:
SUITE 10
Provider Business Mailing Address City Name:
PROVIDENCE
Provider Business Mailing Address State Name:
RI
Provider Business Mailing Address Postal Code:
02906-1329
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
401-214-5923
Provider Business Mailing Address Fax Number:
401-414-0707

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
154 WATERMAN ST.
Provider Second Line Business Practice Location Address:
SUITE 10
Provider Business Practice Location Address City Name:
PROVIDENCE
Provider Business Practice Location Address State Name:
RI
Provider Business Practice Location Address Postal Code:
02906-1329
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
401-214-5923
Provider Business Practice Location Address Fax Number:
401-414-0707
Provider Enumeration Date:
04/19/2016

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 101YA0400X , with the licence number:  CDP00646 , registered in the state of RI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





Copyright © 2007-2025 www.npivalidator.com