Provider Demographics
NPI:1710689385
Name:BRASSARD, KYLE ROBERT (BCBA)
Entity Type:Individual
Prefix:
First Name:KYLE
Middle Name:ROBERT
Last Name:BRASSARD
Suffix:
Gender:M
Credentials:BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15 MORGAN DR UNIT 103
Mailing Address - Street 2:
Mailing Address - City:NATICK
Mailing Address - State:MA
Mailing Address - Zip Code:01760-4294
Mailing Address - Country:US
Mailing Address - Phone:508-202-8248
Mailing Address - Fax:
Practice Address - Street 1:15 MORGAN DR UNIT 103
Practice Address - Street 2:
Practice Address - City:NATICK
Practice Address - State:MA
Practice Address - Zip Code:01760-4294
Practice Address - Country:US
Practice Address - Phone:508-202-8248
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-03-20
Last Update Date:2023-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst