Provider Demographics
NPI:1477899227
Name:SILVA-BOUTWELL, BRIAN SHELTON (BA)
Entity Type:Individual
Prefix:MR
First Name:BRIAN
Middle Name:SHELTON
Last Name:SILVA-BOUTWELL
Suffix:
Gender:M
Credentials:BA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:259 SAMUEL BARNET BLVD
Mailing Address - Street 2:
Mailing Address - City:NEW BEDFORD
Mailing Address - State:MA
Mailing Address - Zip Code:02745-1214
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:259 SAMUEL BARNET BLVD
Practice Address - Street 2:
Practice Address - City:NEW BEDFORD
Practice Address - State:MA
Practice Address - Zip Code:02745-1214
Practice Address - Country:US
Practice Address - Phone:508-995-3251
Practice Address - Fax:508-985-5604
Is Sole Proprietor?:Yes
Enumeration Date:2012-12-26
Last Update Date:2012-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator