Provider Demographics
NPI:1619701737
Name:KERTSIKOF, ARIADNI
Entity type:Individual
Prefix:
First Name:ARIADNI
Middle Name:
Last Name:KERTSIKOF
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:115 AUBURN ST APT 2
Mailing Address - Street 2:
Mailing Address - City:CAMBRIDGE
Mailing Address - State:MA
Mailing Address - Zip Code:02139-4057
Mailing Address - Country:US
Mailing Address - Phone:609-712-3444
Mailing Address - Fax:
Practice Address - Street 1:645 BROADWAY
Practice Address - Street 2:
Practice Address - City:SOMERVILLE
Practice Address - State:MA
Practice Address - Zip Code:02145-2528
Practice Address - Country:US
Practice Address - Phone:781-874-6195
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-08-30
Last Update Date:2024-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health