MEDICARE: MS. BETTINA VELONA

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	101YM0800X	Mental Health Counselor

General Provider Information

NPI Number	:	1508375056
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. BETTINA VELONA

Provider Business Mailing Address
First Line	:	872 MASSACHUSETTS AVE STE 2-1
Second Line	:
City	:	CAMBRIDGE
State	:	MA
Zip	:	02139-3072
Country	:	US
Telephone Number	:	781-277-3015
Fax Number	:

Provider Business Practice Location Address
First Line	:	872 MASSACHUSETTS AVE STE 2-1
Second Line	:
City	:	CAMBRIDGE
State	:	MA
Zip	:	02139-3072
Country	:	US
Telephone Number	:	781-641-7478
Fax Number	:

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

Provider Enumeration Date	:	09/28/2017
Last Update Date	:	01/06/2021

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