Provider Demographics
NPI:1619228129
Name:ALTENA, KETELIE (MSW, CLINICIAN)
Entity type:Individual
Prefix:
First Name:KETELIE
Middle Name:
Last Name:ALTENA
Suffix:
Gender:F
Credentials:MSW, CLINICIAN
Other - Prefix:
Other - First Name:KEKETTE
Other - Middle Name:
Other - Last Name:ALTENA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MSW
Mailing Address - Street 1:2 VIGS WAY
Mailing Address - Street 2:
Mailing Address - City:WORCESTER
Mailing Address - State:MA
Mailing Address - Zip Code:01604-1361
Mailing Address - Country:US
Mailing Address - Phone:508-373-8121
Mailing Address - Fax:
Practice Address - Street 1:10 WINTHROP ST STE 3
Practice Address - Street 2:
Practice Address - City:WORCESTER
Practice Address - State:MA
Practice Address - Zip Code:01604-4445
Practice Address - Country:US
Practice Address - Phone:508-752-4665
Practice Address - Fax:508-752-0947
Is Sole Proprietor?:Yes
Enumeration Date:2012-09-24
Last Update Date:2024-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health