Provider Demographics
NPI:1437935210
Name:BRODEUR, ADAM
Entity Type:Individual
Prefix:
First Name:ADAM
Middle Name:
Last Name:BRODEUR
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 1:217 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:FOXBORO
Mailing Address - State:MA
Mailing Address - Zip Code:02035-1338
Mailing Address - Country:US
Mailing Address - Phone:857-772-0681
Mailing Address - Fax:
Practice Address - Street 1:217 MAIN ST
Practice Address - Street 2:
Practice Address - City:FOXBORO
Practice Address - State:MA
Practice Address - Zip Code:02035-1338
Practice Address - Country:US
Practice Address - Phone:857-772-0681
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-09-06
Last Update Date:2023-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst