Provider Demographics
NPI:1528021623
Name:BELLUARDO-CROSBY, MARK (DMIN, LMHC)
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:
Last Name:BELLUARDO-CROSBY
Suffix:
Gender:M
Credentials:DMIN, LMHC
Other - Prefix:
Other - First Name:MARK
Other - Middle Name:A
Other - Last Name:CROSBY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMHC
Mailing Address - Street 1:PO BOX 2190
Mailing Address - Street 2:
Mailing Address - City:WEST PEABODY
Mailing Address - State:MA
Mailing Address - Zip Code:01960-7190
Mailing Address - Country:US
Mailing Address - Phone:781-231-7026
Mailing Address - Fax:
Practice Address - Street 1:30 FEDERAL ST
Practice Address - Street 2:SUITE B
Practice Address - City:SALEM
Practice Address - State:MA
Practice Address - Zip Code:01970-3869
Practice Address - Country:US
Practice Address - Phone:978-239-7065
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA3719103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA010866OtherHARVARD PILGRIM HEALTHCAR
MA1895061Medicaid
MALM0385OtherBCBS