MEDICARE: JOHN BERTERA PHD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103T00000X	Psychologist	5017	MA

General Provider Information

NPI Number	:	1295784700
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOHN BERTERA PHD

Provider Business Mailing Address
First Line	:	460 WEST MAIN ST
Second Line	:
City	:	HYANNIS
State	:	MA
Zip	:	02601-3653
Country	:	US
Telephone Number	:	508-790-3375
Fax Number	:	508-790-3304

Provider Business Practice Location Address
First Line	:	460 WEST MAIN ST
Second Line	:
City	:	HYANNIS
State	:	MA
Zip	:	02601-3653
Country	:	US
Telephone Number	:	508-790-3375
Fax Number	:	508-790-3304

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/10/2006
Last Update Date	:	11/02/2011

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Directions to “ JOHN BERTERA PHD” Practice Location

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