Healthcare Provider Details

I. General information

NPI: 1275654634
Provider Name (Legal Business Name): COLLEEN FRANCES KUBISCH APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/03/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

489 WHITNEY AVE
HOLYOKE MA
01040-2711
US

IV. Provider business mailing address

843 COUNTRY CLUB RD
GREENFIELD MA
01301-9793
US

V. Phone/Fax

Practice location:
  • Phone: 413-532-6777
  • Fax:
Mailing address:
  • Phone: 413-774-6471
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code364SP0807X
TaxonomyChild & Adolescent Psychiatric/Mental Health Clinical Nurse Specialist
License Number151470
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: