Healthcare Provider Details

I. General information

NPI: 1821229402
Provider Name (Legal Business Name): NICOLE M COUTURE M.S., BCBA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/30/2009
Last Update Date: 07/30/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

786 FRANKLIN RD
JAY ME
04239-4648
US

IV. Provider business mailing address

786 FRANKLIN RD
JAY ME
04239-4648
US

V. Phone/Fax

Practice location:
  • Phone: 617-909-3577
  • Fax:
Mailing address:
  • Phone: 617-909-3577
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-084811
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: