Provider Demographics
NPI:1275610016
Name:KERTENIS, REBECCA (MED, LMFT)
Entity Type:Individual
Prefix:
First Name:REBECCA
Middle Name:
Last Name:KERTENIS
Suffix:
Gender:F
Credentials:MED, LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:35 POST OFFICE PARK
Mailing Address - Street 2:SUITE 3504
Mailing Address - City:WILBRAHAM
Mailing Address - State:MA
Mailing Address - Zip Code:01095-1172
Mailing Address - Country:US
Mailing Address - Phone:413-596-6922
Mailing Address - Fax:
Practice Address - Street 1:35 POST OFFICE PARK
Practice Address - Street 2:SUITE 3504
Practice Address - City:WILBRAHAM
Practice Address - State:MA
Practice Address - Zip Code:01095-1172
Practice Address - Country:US
Practice Address - Phone:413-596-6922
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1205106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA1101642OtherCIGNA BEHAVIORAL HEALTH
MA37489OtherHEALTH NEW ENGLAND