Provider Demographics
NPI:1477822971
Name:BRUNETTO, BROOKE MARIE
Entity Type:Individual
Prefix:MS
First Name:BROOKE
Middle Name:MARIE
Last Name:BRUNETTO
Suffix:
Gender:F
Credentials:
Other - Prefix:MISS
Other - First Name:BROOKE
Other - Middle Name:MARIE
Other - Last Name:BOUCHER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:22 FRONT ST
Mailing Address - Street 2:
Mailing Address - City:FALL RIVER
Mailing Address - State:MA
Mailing Address - Zip Code:02721-4302
Mailing Address - Country:US
Mailing Address - Phone:508-676-1307
Mailing Address - Fax:508-674-4493
Practice Address - Street 1:22 FRONT ST
Practice Address - Street 2:
Practice Address - City:FALL RIVER
Practice Address - State:MA
Practice Address - Zip Code:02721-4302
Practice Address - Country:US
Practice Address - Phone:508-676-1307
Practice Address - Fax:508-674-4493
Is Sole Proprietor?:No
Enumeration Date:2011-12-29
Last Update Date:2011-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MAS87458415101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)