Provider Demographics
NPI:1659804151
Name:BELFORTI, LOREN ELISSA (LICSW)
Entity Type:Individual
Prefix:MS
First Name:LOREN
Middle Name:ELISSA
Last Name:BELFORTI
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:32 HAUTEVALE ST
Mailing Address - Street 2:
Mailing Address - City:ROSLINDALE
Mailing Address - State:MA
Mailing Address - Zip Code:02131-4913
Mailing Address - Country:US
Mailing Address - Phone:774-270-1573
Mailing Address - Fax:
Practice Address - Street 1:32 HAUTEVALE ST
Practice Address - Street 2:
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02131-4913
Practice Address - Country:US
Practice Address - Phone:774-270-1573
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-04-11
Last Update Date:2023-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA121264101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health