Provider Demographics
NPI:1013067529
Name:KANTROWITZ, RICKI ELLEN (PHD)
Entity Type:Individual
Prefix:DR
First Name:RICKI
Middle Name:ELLEN
Last Name:KANTROWITZ
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 1:41 WARBURTON WAY
Mailing Address - Street 2:
Mailing Address - City:NORTHAMPTON
Mailing Address - State:MA
Mailing Address - Zip Code:01060-1658
Mailing Address - Country:US
Mailing Address - Phone:413-586-3970
Mailing Address - Fax:
Practice Address - Street 1:70 COURT ST
Practice Address - Street 2:STE 10
Practice Address - City:WESTFIELD
Practice Address - State:MA
Practice Address - Zip Code:01085-3521
Practice Address - Country:US
Practice Address - Phone:413-562-1011
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-10
Last Update Date:2016-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2616103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAW02764OtherBLUE CROSS BLUE SHIELD
MA13481OtherHEALTH NEW ENGLAND
MA13481OtherHEALTH NEW ENGLAND