Healthcare Provider Details

I. General information

NPI: 1568586782
Provider Name (Legal Business Name): WENDY BLUIS CAC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/16/2007
Last Update Date: 02/29/2024
Certification Date: 02/29/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

72 KILBURN ST
NEW BEDFORD MA
02740-7321
US

IV. Provider business mailing address

72 KILBURN ST
NEW BEDFORD MA
02740-7321
US

V. Phone/Fax

Practice location:
  • Phone: 508-991-7487
  • Fax: 508-991-7487
Mailing address:
  • Phone: 508-991-7487
  • Fax: 508-997-2677

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number439
License Number StateMA
# 2
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number23193
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: