Provider Demographics
NPI:1750750980
Name:BERTELLE, MICHELE GALEA
Entity type:Individual
Prefix:
First Name:MICHELE
Middle Name:GALEA
Last Name:BERTELLE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:MICHELE
Other - Middle Name:TERESA
Other - Last Name:GALEA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:239 GOLDEN HILL LN
Mailing Address - Street 2:SUITE 100
Mailing Address - City:KINGSTON
Mailing Address - State:NY
Mailing Address - Zip Code:12401-6441
Mailing Address - Country:US
Mailing Address - Phone:845-340-4105
Mailing Address - Fax:
Practice Address - Street 1:507 BROADWAY
Practice Address - Street 2:YMCA - ASTOR COUNSELING FT SATELITE
Practice Address - City:KINGSTON
Practice Address - State:NY
Practice Address - Zip Code:12401-3919
Practice Address - Country:US
Practice Address - Phone:845-338-3810
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-09-17
Last Update Date:2015-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYP99116101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health