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General NPI Number Information
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NPI Number | 1194087544
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Entity Type | Individual
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Provider Name | KIRSTEN SEKULA M.S.W
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Gender | Female
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Dates
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Enumeration Date | 06/12/2012
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Last Update Date | 09/05/2024
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Provider Practice Location Address
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Address Line | 1115 W CHESTNUT ST
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City | BROCKTON
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State | MA
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Zip | 02301-7501
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Country | US
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Telephone | 508-580-4691
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Fax |
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Provider Business Mailing Address
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Address Line | 5 TORWOOD CIR
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City | PITTSFORD
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State | NY
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Zip | 14534-1417
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Country | US
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Telephone | 585-489-5881
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 125394
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License Number State | MA
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Taxonomy #2
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Taxonomy Code | 104100000X
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Taxonomy Name | Social Worker
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License Number |
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License Number State |
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