Provider Demographics
NPI:1215681499
Name:ARGUETA, BERTHA ILEANA (AMFT)
Entity type:Individual
Prefix:
First Name:BERTHA
Middle Name:ILEANA
Last Name:ARGUETA
Suffix:
Gender:F
Credentials:AMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:69 COBURN AVE
Mailing Address - Street 2:
Mailing Address - City:NEWINGTON
Mailing Address - State:CT
Mailing Address - Zip Code:06111-3332
Mailing Address - Country:US
Mailing Address - Phone:781-354-5313
Mailing Address - Fax:
Practice Address - Street 1:93 MARKET SQ STE 5
Practice Address - Street 2:
Practice Address - City:NEWINGTON
Practice Address - State:CT
Practice Address - Zip Code:06111-2900
Practice Address - Country:US
Practice Address - Phone:781-354-5313
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-02-07
Last Update Date:2022-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT2809106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist