Provider Demographics
NPI:1275699795
Name:GUERTIN, CATHARINE JEAN (DC, M-PAS)
Entity Type:Individual
Prefix:DR
First Name:CATHARINE
Middle Name:JEAN
Last Name:GUERTIN
Suffix:
Gender:F
Credentials:DC, M-PAS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20 JEFFERSON AVE
Mailing Address - Street 2:
Mailing Address - City:CHICOPEE
Mailing Address - State:MA
Mailing Address - Zip Code:01020-1034
Mailing Address - Country:US
Mailing Address - Phone:413-348-8019
Mailing Address - Fax:413-533-5028
Practice Address - Street 1:165 DILLABUR AVE
Practice Address - Street 2:
Practice Address - City:NORTH KINGSTOWN
Practice Address - State:RI
Practice Address - Zip Code:02852-1009
Practice Address - Country:US
Practice Address - Phone:413-592-2828
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-29
Last Update Date:2012-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2909111NN1001X
RIPA00541363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No111NN1001XChiropractic ProvidersChiropractorNutrition
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAY37111OtherBLUE CROSS
MA7869817OtherAETNA
MA697304OtherACN GROUP
MA697304OtherACN GROUP
MA7869817OtherAETNA