Provider Demographics
NPI:1780654111
Name:SPECKERT, JOSEFINA AMALIA (MED, LMHC, LMFT)
Entity Type:Individual
Prefix:
First Name:JOSEFINA
Middle Name:AMALIA
Last Name:SPECKERT
Suffix:
Gender:F
Credentials:MED, LMHC, LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:111 PITTSFIELD RD
Mailing Address - Street 2:
Mailing Address - City:HINSDALE
Mailing Address - State:MA
Mailing Address - Zip Code:01235-9459
Mailing Address - Country:US
Mailing Address - Phone:413-655-0265
Mailing Address - Fax:
Practice Address - Street 1:73 RUSSELL RD
Practice Address - Street 2:
Practice Address - City:HUNTINGTON
Practice Address - State:MA
Practice Address - Zip Code:01050-9777
Practice Address - Country:US
Practice Address - Phone:413-667-0039
Practice Address - Fax:413-667-8746
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA240101YM0800X, 106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Not Answered106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA21386OtherHEALTH NEW ENGLAND
MALM0959OtherBCBSMA
MA175472000OtherMAGELLAN HEALTH SERVICES
333746OtherMNAGED HEALTH CARE