Doctor Name: | MARIE BERTRAND |
NPI Number: | 1063785434 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | |
License Number: | |
Business Practice Address: | 15 Christopher St Dorchester, MA - 021221218 |
Business Phone Number: | 6172887450 |
Business Fax Number: | |
Mailing Address: | 64 West St, HYDE PARK |
State: | MA |
Postal Code: | 021363049 |
Phone Number: | |
Fax Number: | |
NPI Enumeration Date: | 02/16/2012 |
NPI Last Update Date: | 02/16/2012 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 101YM0800X |
License Number: | |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Counselor |
Taxonomy Specialization: | Mental Health |
Taxonomy Definition: |