Provider Demographics
NPI:1497393342
Name:KEGRESSE, CELINA MARIE
Entity Type:Individual
Prefix:
First Name:CELINA
Middle Name:MARIE
Last Name:KEGRESSE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:317 LENOX AVE
Mailing Address - Street 2:
Mailing Address - City:PITTSFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01201-2638
Mailing Address - Country:US
Mailing Address - Phone:413-854-4700
Mailing Address - Fax:
Practice Address - Street 1:317 LENOX AVE
Practice Address - Street 2:
Practice Address - City:PITTSFIELD
Practice Address - State:MA
Practice Address - Zip Code:01201-2638
Practice Address - Country:US
Practice Address - Phone:413-854-4700
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-12-11
Last Update Date:2019-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist