Provider Demographics
NPI:1942448964
Name:COUTURE (MOSCHELLA), JANET GENEVIEVE (PSYD)
Entity Type:Individual
Prefix:
First Name:JANET
Middle Name:GENEVIEVE
Last Name:COUTURE (MOSCHELLA)
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5 FOLEY DR
Mailing Address - Street 2:
Mailing Address - City:SOUTHBOROUGH
Mailing Address - State:MA
Mailing Address - Zip Code:01772-1603
Mailing Address - Country:US
Mailing Address - Phone:508-303-3453
Mailing Address - Fax:
Practice Address - Street 1:5 FOLEY DR
Practice Address - Street 2:
Practice Address - City:SOUTHBOROUGH
Practice Address - State:MA
Practice Address - Zip Code:01772-1603
Practice Address - Country:US
Practice Address - Phone:508-303-3453
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-01-29
Last Update Date:2009-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA6784103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical