Provider Demographics
NPI:1336374404
Name:BERTONI, SEAN
Entity Type:Individual
Prefix:
First Name:SEAN
Middle Name:
Last Name:BERTONI
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 1:35 SUMMER ST
Mailing Address - Street 2:
Mailing Address - City:TAUNTON
Mailing Address - State:MA
Mailing Address - Zip Code:02780-3469
Mailing Address - Country:US
Mailing Address - Phone:508-681-9377
Mailing Address - Fax:508-884-2476
Practice Address - Street 1:35 SUMMER ST
Practice Address - Street 2:
Practice Address - City:TAUNTON
Practice Address - State:MA
Practice Address - Zip Code:02780-3469
Practice Address - Country:US
Practice Address - Phone:508-681-9377
Practice Address - Fax:508-884-2476
Is Sole Proprietor?:Yes
Enumeration Date:2009-05-19
Last Update Date:2010-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MAS49866178171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator