MEDICARE: MS. DOMINIQUE BELLEGARDE CLC,CLE,CCHW

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	174N00000X	Lactation Consultant (Non-RN)
2	176B00000X	Midwife
3	374J00000X	Doula		MA
4	172V00000X	Community Health Worker	CHW00280	MA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	33659	OTHER	MA	LACTATION

General Provider Information

NPI Number	:	1366177602
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. DOMINIQUE BELLEGARDE CLC,CLE,CCHW

Provider Business Mailing Address
First Line	:	306 WASHINGTON ST APT 3
Second Line	:
City	:	DORCHESTER
State	:	MA
Zip	:	02121-3971
Country	:	US
Telephone Number	:	617-892-3634
Fax Number	:

Provider Business Practice Location Address
First Line	:	306 WASHINGTON ST APT 3
Second Line	:
City	:	BOSTON
State	:	MA
Zip	:	02121-3971
Country	:	US
Telephone Number	:	617-329-1277
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/20/2022
Last Update Date	:	10/20/2023

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