Provider Demographics
NPI:1790996494
Name:BRETTO, KENDALL V
Entity Type:Individual
Prefix:MS
First Name:KENDALL
Middle Name:V
Last Name:BRETTO
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 1:98 COMMERCIAL ST
Mailing Address - Street 2:2R
Mailing Address - City:WEYMOUTH
Mailing Address - State:MA
Mailing Address - Zip Code:02188-2605
Mailing Address - Country:US
Mailing Address - Phone:617-669-0446
Mailing Address - Fax:
Practice Address - Street 1:98 COMMERCIAL ST
Practice Address - Street 2:2R
Practice Address - City:WEYMOUTH
Practice Address - State:MA
Practice Address - Zip Code:02188-2605
Practice Address - Country:US
Practice Address - Phone:617-669-0446
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist