Provider Demographics
NPI:1285894527
Name:RANDOLPH-COUTURE, AMY ROBERTA (MA, LMHC)
Entity type:Individual
Prefix:MS
First Name:AMY
Middle Name:ROBERTA
Last Name:RANDOLPH-COUTURE
Suffix:
Gender:F
Credentials:MA, LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:69 WENHAM ST
Mailing Address - Street 2:
Mailing Address - City:JAMAICA PLAIN
Mailing Address - State:MA
Mailing Address - Zip Code:02130-4152
Mailing Address - Country:US
Mailing Address - Phone:617-816-1615
Mailing Address - Fax:
Practice Address - Street 1:69 WENHAM ST
Practice Address - Street 2:
Practice Address - City:JAMAICA PLAIN
Practice Address - State:MA
Practice Address - Zip Code:02130-4152
Practice Address - Country:US
Practice Address - Phone:617-816-1615
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-10
Last Update Date:2008-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA6119101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health