Provider Demographics
NPI:1679389639
Name:MAYES, NATREECE RENEE
Entity type:Individual
Prefix:
First Name:NATREECE
Middle Name:RENEE
Last Name:MAYES
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:426 EAST ST # A
Mailing Address - Street 2:
Mailing Address - City:NEW HAVEN
Mailing Address - State:CT
Mailing Address - Zip Code:06511-5018
Mailing Address - Country:US
Mailing Address - Phone:203-495-7710
Mailing Address - Fax:203-495-7713
Practice Address - Street 1:426 EAST ST
Practice Address - Street 2:
Practice Address - City:NEW HAVEN
Practice Address - State:CT
Practice Address - Zip Code:06511-5018
Practice Address - Country:US
Practice Address - Phone:203-495-7710
Practice Address - Fax:203-495-7713
Is Sole Proprietor?:Yes
Enumeration Date:2024-12-05
Last Update Date:2024-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT1585101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)