Healthcare Provider Details

I. General information

NPI: 1972365898
Provider Name (Legal Business Name): BRIANNA M CERUTTI
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/25/2024
Last Update Date: 06/19/2026
Certification Date: 06/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

43 HARVARD ST
WORCESTER MA
01609-2836
US

IV. Provider business mailing address

1 PHEASANT LN
CLINTON MA
01510-1464
US

V. Phone/Fax

Practice location:
  • Phone: 800-679-3609
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License NumberLABA10001016
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: