MEDICARE: WENDY BLUIS CAC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YA0400X	Addiction (Substance Use Disorder) Counselor	439	MA
2	101YA0400X	Addiction (Substance Use Disorder) Counselor	23193	MA

General Provider Information

NPI Number	:	1568586782
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	WENDY BLUIS CAC

Provider Business Mailing Address
First Line	:	72 KILBURN ST
Second Line	:
City	:	NEW BEDFORD
State	:	MA
Zip	:	02740-7321
Country	:	US
Telephone Number	:	508-991-7487
Fax Number	:	508-997-2677

Provider Business Practice Location Address
First Line	:	72 KILBURN ST
Second Line	:
City	:	NEW BEDFORD
State	:	MA
Zip	:	02740-7321
Country	:	US
Telephone Number	:	508-991-7487
Fax Number	:	508-991-7487

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/16/2007
Last Update Date	:	02/29/2024

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