1790088078 NPI number — MS. REBECCA BELIZAIRE LMHC, LMFT

Table of content: MS. REBECCA BELIZAIRE LMHC, LMFT (NPI 1790088078)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1790088078 NPI number — MS. REBECCA BELIZAIRE LMHC, LMFT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BELIZAIRE
Provider First Name:
REBECCA
Provider Middle Name:
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
LMHC, LMFT
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1790088078
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/20/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
337 WASHINGTON ST UNIT 81631
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WELLESLEY HILLS
Provider Business Mailing Address State Name:
MA
Provider Business Mailing Address Postal Code:
02481-8121
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
617-249-4142
Provider Business Mailing Address Fax Number:
855-420-6895

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
540 VFW PKWY
Provider Second Line Business Practice Location Address:
SUITE 4
Provider Business Practice Location Address City Name:
WEST ROXBURY
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
02132-1332
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
617-325-2993
Provider Business Practice Location Address Fax Number:
617-325-5618
Provider Enumeration Date:
12/08/2010

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 101YM0800X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





Copyright © 2007-2024 www.npivalidator.com