Provider Demographics
NPI:1336791110
Name:TRETTER, BENJAMIN M (MSN, PMH-NP)
Entity Type:Individual
Prefix:
First Name:BENJAMIN
Middle Name:M
Last Name:TRETTER
Suffix:
Gender:M
Credentials:MSN, PMH-NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:28 BELKNAP ST
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:MA
Mailing Address - Zip Code:02474-6620
Mailing Address - Country:US
Mailing Address - Phone:603-236-6538
Mailing Address - Fax:
Practice Address - Street 1:2033 MAIN ST
Practice Address - Street 2:
Practice Address - City:ATHOL
Practice Address - State:MA
Practice Address - Zip Code:01331-3535
Practice Address - Country:US
Practice Address - Phone:978-249-9490
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-07-12
Last Update Date:2019-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MARN2274857363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health