Healthcare Provider Details

I. General information

NPI: 1194087544
Provider Name (Legal Business Name): KIRSTEN SEKULA M.S.W
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/12/2012
Last Update Date: 09/05/2024
Certification Date: 09/05/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1115 W CHESTNUT ST
BROCKTON MA
02301-7501
US

IV. Provider business mailing address

5 TORWOOD CIR
PITTSFORD NY
14534-1417
US

V. Phone/Fax

Practice location:
  • Phone: 508-580-4691
  • Fax:
Mailing address:
  • Phone: 585-489-5881
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number125394
License Number StateMA
# 2
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: