Healthcare Provider Details

I. General information

NPI: 1275992083
Provider Name (Legal Business Name): MARYBETH KUTA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/22/2016
Last Update Date: 02/22/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

511 E COLUMBUS AVE
SPRINGFIELD MA
01105-2506
US

IV. Provider business mailing address

8 ETHAN AVE
WESTFIELD MA
01085-1116
US

V. Phone/Fax

Practice location:
  • Phone: 413-827-8959
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: