Kassondra Bertulis, PSYD

Primary specialty

Clinical NeuropsychologistTaxonomy code 103G00000X

License

PSY.0006447 Issued in CO

Practice address

718 Smyth Rd
Manchester, NH 03104-7007

Phone

(860) 378-5955

NPI assigned

Jun 28, 2024

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1719532800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1719532800000",
    "number": "1245075472",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "27 WATER ST APT 306",
            "city": "WAKEFIELD",
            "state": "MA",
            "postal_code": "018803026",
            "telephone_number": "860-378-5595"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "718 SMYTH RD",
            "city": "MANCHESTER",
            "state": "NH",
            "postal_code": "031047007",
            "telephone_number": "860-378-5955"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "200 Springs Rd",
            "address_purpose": "LOCATION",
            "city": "Bedford",
            "state": "MA",
            "postal_code": "017301198",
            "country_code": "US",
            "telephone_number": "781-674-6885",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "BERTULIS",
        "first_name": "KASSONDRA",
        "name_prefix": "Dr.",
        "credential": "PSYD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2024-06-28",
        "last_updated": "2024-06-28",
        "certification_date": "2024-06-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103G00000X",
            "taxonomy_group": "",
            "desc": "Clinical Neuropsychologist",
            "state": "CO",
            "license": "PSY.0006447",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Tierica Berry, RBT
• Karen E Berthiaume, RPH
• Erin Bertoli, BCBA, LBS
• Melissa Renee Bertoulin, MSW LICSW
• Carmen Bertran, LCMHC
• Randy G Berube, PT
• Richard G Berube, D.M.D
• Stephen Berube, D.M.D
• Beryl Inpatient Services
• Yulia Bespalova

• Clinical Neuropsychologist in Manchester, NH
• Providers in Manchester, NH by specialty
• Clinical Neuropsychologist in New Hampshire

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 28, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.