Basic Information
| Provider Information | |||||||||
| NPI: | 1952696106 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BRIGHT | ||||||||
| FirstName: | KIRSTEN | ||||||||
| MiddleName: | MARIE | ||||||||
| NamePrefix: | |||||||||
| NameSuffix: | |||||||||
| Credential: | L.M.F.T. | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | SMOLSKIS | ||||||||
| OtherFirstName: | KIRSTEN | ||||||||
| OtherMiddleName: | MARIE | ||||||||
| OtherNamePrefix: | |||||||||
| OtherNameSuffix: | |||||||||
| OtherCredential: | M.A. | ||||||||
| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 211 N MAIN ST | ||||||||
| Address2: | |||||||||
| City: | PETERSHAM | ||||||||
| State: | MA | ||||||||
| PostalCode: | 013669503 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7892491122 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 211 N MAIN ST | ||||||||
| Address2: | |||||||||
| City: | PETERSHAM | ||||||||
| State: | MA | ||||||||
| PostalCode: | 013669503 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5087659167 | ||||||||
| FaxNumber: | 5087642462 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/16/2011 | ||||||||
| LastUpdateDate: | 06/22/2021 | ||||||||
| NPIDeactivationReasonCode: | |||||||||
| NPIDeactivationDate: | |||||||||
| NPIReactivationDate: | |||||||||
| ProviderGenderCode: | F | ||||||||
| AuthorizedOfficialLastName: | |||||||||
| AuthorizedOfficialFirstName: | |||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | |||||||||
| AuthorizedOfficialTelephone: | |||||||||
| IsSoleProprietor: | N | ||||||||
| IsOrganizationSubpart: | |||||||||
| ParentOrganizationLBN: | |||||||||
| AuthorizedOfficialNamePrefix: | |||||||||
| AuthorizedOfficialNameSuffix: | |||||||||
| AuthorizedOfficialCredential: | |||||||||
| NPICertificationDate: | 06/22/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YM0800X | N | Behavioral Health & Social Service Providers | Counselor | Mental Health | 106H00000X | 1454 | MA | Y | Behavioral Health & Social Service Providers | Marriage & Family Therapist |
ID Information
| ID | Type | State | Issuer | Description | 04-2103577 | 01 | MA | UBH | OTHER | 110024448C | 05 | MA | MEDICAID | 900293 | 01 | MA | TUFTS | OTHER | 1005300 | 01 | MA | BEACON | OTHER | 110024448C | 01 | MA | MBHP | OTHER | 2222001910 | 01 | MA | BCBS | OTHER |