Healthcare Provider Details

I. General information

NPI: 1851412209
Provider Name (Legal Business Name): ANNE B BELLEFEUILLE PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/03/2007
Last Update Date: 08/15/2023
Certification Date: 08/15/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

85 CONSTITUTION LN # 300A
DANVERS MA
01923-3694
US

IV. Provider business mailing address

85 CONSTITUTION LN STE 300A
DANVERS MA
01923-3694
US

V. Phone/Fax

Practice location:
  • Phone: 978-626-1105
  • Fax: 978-750-0766
Mailing address:
  • Phone: 978-626-1105
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number8686
License Number StateMA
# 2
Primary TaxonomyY
Taxonomy Code103G00000X
TaxonomyClinical Neuropsychologist
License Number8686
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: