Provider Demographics
NPI:1083475305
Name:CRUDGINGTON, BRETT STEPHEN
Entity Type:Individual
Prefix:MR
First Name:BRETT
Middle Name:STEPHEN
Last Name:CRUDGINGTON
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:309 ALLSTON ST APT 10
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02135-7629
Mailing Address - Country:US
Mailing Address - Phone:347-775-4081
Mailing Address - Fax:
Practice Address - Street 1:309 ALLSTON ST APT 10
Practice Address - Street 2:
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02135-7629
Practice Address - Country:US
Practice Address - Phone:347-775-4081
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-01-23
Last Update Date:2024-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health