Provider Demographics
NPI:1508935024
Name:BERTUCH, ELIZABETH ANN (MS, APRN, BC, PC)
Entity Type:Individual
Prefix:MS
First Name:ELIZABETH
Middle Name:ANN
Last Name:BERTUCH
Suffix:
Gender:F
Credentials:MS, APRN, BC, PC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:114 WHITE LOAF RD
Mailing Address - Street 2:
Mailing Address - City:SOUTHAMPTON
Mailing Address - State:MA
Mailing Address - Zip Code:01073-9550
Mailing Address - Country:US
Mailing Address - Phone:413-532-6777
Mailing Address - Fax:413-532-6777
Practice Address - Street 1:117 PARK AVE STE 300
Practice Address - Street 2:
Practice Address - City:WEST SPRINGFIELD
Practice Address - State:MA
Practice Address - Zip Code:01089-3363
Practice Address - Country:US
Practice Address - Phone:141-353-2677
Practice Address - Fax:413-532-6744
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-07
Last Update Date:2021-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA194060364SP0809X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SP0809XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPsychiatric/Mental Health, Adult