=====================================================
General NPI Number Information
=====================================================
NPI Number | 1518258631
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | NORBERT ARTHUR BELLIVEAU LICSW
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/23/2011
-----------------------------------------------------
Last Update Date | 02/13/2013
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 8 TRUMBULL RD SUITE 304
-----------------------------------------------------
City | NORTHAMPTON
-----------------------------------------------------
State | MA
-----------------------------------------------------
Zip | 01060-3079
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 413-588-2472
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 8 TRUMBULL RD SUITE 304
-----------------------------------------------------
City | NORTHAMPTON
-----------------------------------------------------
State | MA
-----------------------------------------------------
Zip | 01060-3079
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 413-588-2472
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1041C0700X
-----------------------------------------------------
Taxonomy Name | Clinical Social Worker
-----------------------------------------------------
License Number | 116132
-----------------------------------------------------
License Number State | MA
-----------------------------------------------------