Basic Information
| Provider Information | |||||||||
| NPI: | 1013009935 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BERTOT | ||||||||
| FirstName: | SECRETTE | ||||||||
| MiddleName: | ANTOINETTE | ||||||||
| NamePrefix: | PROF. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MS, NCC,LPC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 25 IKEA DR | ||||||||
| Address2: | |||||||||
| City: | WESTAMPTON | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 080605115 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8569060672 | ||||||||
| FaxNumber: | 8569060672 | ||||||||
| Practice Location | |||||||||
| Address1: | 25 IKEA DR | ||||||||
| Address2: | |||||||||
| City: | WESTAMPTON | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 080605115 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6092679339 | ||||||||
| FaxNumber: | 6092676655 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/28/2006 | ||||||||
| LastUpdateDate: | 11/03/2016 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YM0800X | Y | Behavioral Health & Social Service Providers | Counselor | Mental Health |
No ID Information.