Provider Demographics
NPI:1578615159
Name:GORFINE, TETTY (MA)
Entity Type:Individual
Prefix:MS
First Name:TETTY
Middle Name:
Last Name:GORFINE
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:146 OLD SUNDERLAND RD
Mailing Address - Street 2:
Mailing Address - City:MONTAGUE
Mailing Address - State:MA
Mailing Address - Zip Code:01351-9549
Mailing Address - Country:US
Mailing Address - Phone:413-367-9874
Mailing Address - Fax:
Practice Address - Street 1:123 HAWLEY ST
Practice Address - Street 2:
Practice Address - City:NORTHAMPTON
Practice Address - State:MA
Practice Address - Zip Code:01060-3366
Practice Address - Country:US
Practice Address - Phone:413-585-1655
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-17
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1115101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MALM0747OtherBLUE CROSS BLUE SHIELD
MA1890697Medicaid