Provider Demographics
NPI:1801418033
Name:COUTURE, BRANDON M
Entity type:Individual
Prefix:
First Name:BRANDON
Middle Name:M
Last Name:COUTURE
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 1:3595 POST RD APT 18207
Mailing Address - Street 2:
Mailing Address - City:WARWICK
Mailing Address - State:RI
Mailing Address - Zip Code:02886-7047
Mailing Address - Country:US
Mailing Address - Phone:401-258-0035
Mailing Address - Fax:
Practice Address - Street 1:22 HIGH STREET
Practice Address - Street 2:#1
Practice Address - City:WALTHAM
Practice Address - State:MA
Practice Address - Zip Code:02453
Practice Address - Country:US
Practice Address - Phone:401-258-0035
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-05-11
Last Update Date:2024-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health