Provider Demographics
NPI:1932395662
Name:TORKELSON, BRETTON PATTON (PSYD)
Entity Type:Individual
Prefix:
First Name:BRETTON
Middle Name:PATTON
Last Name:TORKELSON
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:360 WOODLAND ST
Mailing Address - Street 2:
Mailing Address - City:HOLLISTON
Mailing Address - State:MA
Mailing Address - Zip Code:01746-1826
Mailing Address - Country:US
Mailing Address - Phone:774-233-2932
Mailing Address - Fax:
Practice Address - Street 1:360 WOODLAND ST
Practice Address - Street 2:
Practice Address - City:HOLLISTON
Practice Address - State:MA
Practice Address - Zip Code:01746-1826
Practice Address - Country:US
Practice Address - Phone:774-233-2932
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-17
Last Update Date:2020-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA11282103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist