Provider Demographics
NPI:1730469909
Name:BLESEDELL, AMBER BETH (LMFT)
Entity Type:Individual
Prefix:
First Name:AMBER
Middle Name:BETH
Last Name:BLESEDELL
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:AMBER
Other - Middle Name:B
Other - Last Name:HOLCOMB
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MFT
Mailing Address - Street 1:104 MASCUPPIC TRL
Mailing Address - Street 2:
Mailing Address - City:TYNGSBORO
Mailing Address - State:MA
Mailing Address - Zip Code:01879-1732
Mailing Address - Country:US
Mailing Address - Phone:802-598-9447
Mailing Address - Fax:
Practice Address - Street 1:104 MASCUPPIC TRL
Practice Address - Street 2:
Practice Address - City:TYNGSBORO
Practice Address - State:MA
Practice Address - Zip Code:01879-1732
Practice Address - Country:US
Practice Address - Phone:802-598-9447
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-08-19
Last Update Date:2023-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1480106H00000X
106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist