Provider Demographics
NPI:1194499624
Name:COUFOS, NICHOLAS FRANCIS
Entity type:Individual
Prefix:MR
First Name:NICHOLAS
Middle Name:FRANCIS
Last Name:COUFOS
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 1:17 WINTER ST APT 19
Mailing Address - Street 2:
Mailing Address - City:WATERTOWN
Mailing Address - State:MA
Mailing Address - Zip Code:02472-3854
Mailing Address - Country:US
Mailing Address - Phone:508-479-0408
Mailing Address - Fax:
Practice Address - Street 1:17 WINTER ST APT 19
Practice Address - Street 2:
Practice Address - City:WATERTOWN
Practice Address - State:MA
Practice Address - Zip Code:02472-3854
Practice Address - Country:US
Practice Address - Phone:508-479-0408
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-08-07
Last Update Date:2021-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician