Provider Demographics
NPI:1942799846
Name:PRUETT, MARSHA KLINE (PHD)
Entity Type:Individual
Prefix:
First Name:MARSHA
Middle Name:KLINE
Last Name:PRUETT
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:40 TRUMBULL RD
Mailing Address - Street 2:
Mailing Address - City:NORTHAMPTON
Mailing Address - State:MA
Mailing Address - Zip Code:01060-3023
Mailing Address - Country:US
Mailing Address - Phone:413-584-5811
Mailing Address - Fax:
Practice Address - Street 1:57 GOTHIC ST
Practice Address - Street 2:
Practice Address - City:NORTHAMPTON
Practice Address - State:MA
Practice Address - Zip Code:01060-3047
Practice Address - Country:US
Practice Address - Phone:413-584-3200
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-05-07
Last Update Date:2018-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA9478103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical