Healthcare Provider Details

I. General information

NPI: 1659286797
Provider Name (Legal Business Name): KIMBERLY JOY BRESSEM LEP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/14/2026
Last Update Date: 08/14/2026
Certification Date: 08/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

64 SCHOOL ST
HATFIELD MA
01038-9747
US

IV. Provider business mailing address

64 SCHOOL ST
HATFIELD MA
01038-9747
US

V. Phone/Fax

Practice location:
  • Phone: 413-727-2712
  • Fax:
Mailing address:
  • Phone: 413-727-2712
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number964
License Number StateMA
# 2
Primary TaxonomyN
Taxonomy Code103TS0200X
TaxonomySchool Psychologist
License Number8276715435
License Number StateCT
# 3
Primary TaxonomyY
Taxonomy Code103TS0200X
TaxonomySchool Psychologist
License Number354161
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: