Provider Demographics
NPI:1821229402
Name:COUTURE, NICOLE M (MS, BCBA)
Entity Type:Individual
Prefix:
First Name:NICOLE
Middle Name:M
Last Name:COUTURE
Suffix:
Gender:F
Credentials:MS, BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:786 FRANKLIN RD
Mailing Address - Street 2:
Mailing Address - City:JAY
Mailing Address - State:ME
Mailing Address - Zip Code:04239-4648
Mailing Address - Country:US
Mailing Address - Phone:617-909-3577
Mailing Address - Fax:
Practice Address - Street 1:786 FRANKLIN RD
Practice Address - Street 2:
Practice Address - City:JAY
Practice Address - State:ME
Practice Address - Zip Code:04239-4648
Practice Address - Country:US
Practice Address - Phone:617-909-3577
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-30
Last Update Date:2009-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME1-084811103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst