Provider Demographics
NPI:1457438889
Name:KERTESZ, JOSEPH W (MA)
Entity Type:Individual
Prefix:MR
First Name:JOSEPH
Middle Name:W
Last Name:KERTESZ
Suffix:
Gender:M
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2450 DELANEY RD
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:28403-6062
Mailing Address - Country:US
Mailing Address - Phone:910-763-5522
Mailing Address - Fax:910-763-0413
Practice Address - Street 1:2450 DELANEY RD
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:NC
Practice Address - Zip Code:28403-6062
Practice Address - Country:US
Practice Address - Phone:910-763-9512
Practice Address - Fax:910-763-6339
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-01
Last Update Date:2007-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC404101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6103667Medicaid