Provider Demographics
NPI:1568067668
Name:BLEFARI, ADAM G (PSYD, NCSP)
Entity Type:Individual
Prefix:DR
First Name:ADAM
Middle Name:G
Last Name:BLEFARI
Suffix:
Gender:M
Credentials:PSYD, NCSP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21 RIVERVIEW DR
Mailing Address - Street 2:
Mailing Address - City:DALTON
Mailing Address - State:MA
Mailing Address - Zip Code:01226-1312
Mailing Address - Country:US
Mailing Address - Phone:413-250-0134
Mailing Address - Fax:
Practice Address - Street 1:269 1ST ST
Practice Address - Street 2:
Practice Address - City:PITTSFIELD
Practice Address - State:MA
Practice Address - Zip Code:01201-4727
Practice Address - Country:US
Practice Address - Phone:413-499-9515
Practice Address - Fax:413-499-9559
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-04
Last Update Date:2020-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC5416103TC2200X
MA506976103TS0200X
MA11295103TC2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent
No103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool