Doctor Name: | KELLY GUERTIN |
NPI Number: | 1073941522 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | |
License Number: | |
Business Practice Address: | 433 Valley St Willimantic, CT - 062261901 |
Business Phone Number: | 8604567200 |
Business Fax Number: | 8604567202 |
Mailing Address: | 433 Valley St, WILLIMANTIC |
State: | CT |
Postal Code: | 062261901 |
Phone Number: | 8604567200 |
Fax Number: | 8604567202 |
NPI Enumeration Date: | 10/18/2013 |
NPI Last Update Date: | 10/18/2013 |
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: |