Provider Demographics
NPI:1770864092
Name:FEDORA, KURT ANDREW
Entity Type:Individual
Prefix:
First Name:KURT
Middle Name:ANDREW
Last Name:FEDORA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:78 POMEROY TER
Mailing Address - Street 2:
Mailing Address - City:NORTHAMPTON
Mailing Address - State:MA
Mailing Address - Zip Code:01060-3378
Mailing Address - Country:US
Mailing Address - Phone:413-584-1310
Mailing Address - Fax:413-586-1496
Practice Address - Street 1:78 POMEROY TER
Practice Address - Street 2:
Practice Address - City:NORTHAMPTON
Practice Address - State:MA
Practice Address - Zip Code:01060-3378
Practice Address - Country:US
Practice Address - Phone:413-584-1310
Practice Address - Fax:413-586-1496
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-31
Last Update Date:2011-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor