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General NPI Number Information
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NPI Number | 1326491549
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Entity Type | Individual
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Provider Name | KYLE JASON CORTIS
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Gender | Male
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Dates
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Enumeration Date | 07/22/2016
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Last Update Date | 03/23/2022
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Provider Practice Location Address
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Address Line | 280 N MAIN ST
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City | EAST LONGMEADOW
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State | MA
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Zip | 01028-1868
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Country | US
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Telephone | 413-642-1672
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Fax |
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Provider Business Mailing Address
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Address Line | 22 CEDAR LN
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City | WESTFIELD
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State | MA
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Zip | 01085-4604
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Country | US
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Telephone | 413-642-1572
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Fax | 413-327-9894
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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 |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 12480
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License Number State | MA
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