Most Relevant Information
Provider Data
| NPI Number: | 1003673278 |
| Provider Name: | BERTHANIA BOURSIQUOT LPCA |
| Entity Type: | Individual |
| Taxonomy Code: | 101YM0800X |
| Specialty: | Counselor |
| License Number: | 005716 |
Most Important Dates
| Enumeration Date: | 03/04/2024 |
| Last Updated: | 03/04/2024 |
Provider Practice Location
949 BRIDGEPORT AVE
MILFORD
CT
064603142
Practice Location Phone/Fax
| Phone: | 2038786365 |
| Fax: | 2033012397 |
Provider Mailing Location
949 BRIDGEPORT AVE
MILFORD
CT
064603142
Provider Mailing Phone/Fax
| Phone: | 2038786365 |
| Fax: | 2033012397 |