Healthcare Provider Details

I. General information

NPI: 1295764694
Provider Name (Legal Business Name): AIMEE W. BELLOWS PH.D
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/30/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9 WARE ST APT 7
CAMBRIDGE MA
02138-4012
US

IV. Provider business mailing address

9 WARE ST APT 7
CAMBRIDGE MA
02138-4012
US

V. Phone/Fax

Practice location:
  • Phone: 617-876-6679
  • Fax:
Mailing address:
  • Phone: 617-876-6679
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPS00173
License Number StateRI
# 2
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number1937
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: