Healthcare Provider Details

I. General information

NPI: 1588295844
Provider Name (Legal Business Name): ELIZABETH BELLONE CCC-SLP, BCBA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: BETH BELLONE CCC-SLP, BCBA

II. Dates (important events)

Enumeration Date: 01/27/2020
Last Update Date: 01/27/2020
Certification Date: 01/27/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

33 TURNPIKE RD
SOUTHBOROUGH MA
01772-2108
US

IV. Provider business mailing address

33 TURNPIKE RD
SOUTHBOROUGH MA
01772-2108
US

V. Phone/Fax

Practice location:
  • Phone: 508-481-1015
  • Fax:
Mailing address:
  • Phone: 508-481-1015
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number328
License Number StateMA
# 2
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number3782
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: