Provider Demographics
NPI:1609331115
Name:REUTER, BRANDON KARL
Entity Type:Individual
Prefix:MR
First Name:BRANDON
Middle Name:KARL
Last Name:REUTER
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 1:7 HIGHLAND AVE APT 4
Mailing Address - Street 2:
Mailing Address - City:BEVERLY
Mailing Address - State:MA
Mailing Address - Zip Code:01915-4973
Mailing Address - Country:US
Mailing Address - Phone:845-546-3612
Mailing Address - Fax:
Practice Address - Street 1:152 SYLVAN ST STE 210
Practice Address - Street 2:
Practice Address - City:DANVERS
Practice Address - State:MA
Practice Address - Zip Code:01923-3558
Practice Address - Country:US
Practice Address - Phone:774-213-2375
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-02-08
Last Update Date:2019-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VIRBT-16-23060106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician