Provider Demographics
NPI:1851412209
Name:BELLEFEUILLE, ANNE B (PHD)
Entity Type:Individual
Prefix:DR
First Name:ANNE
Middle Name:B
Last Name:BELLEFEUILLE
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:85 CONSTITUTION LN STE 300A
Mailing Address - Street 2:
Mailing Address - City:DANVERS
Mailing Address - State:MA
Mailing Address - Zip Code:01923-3694
Mailing Address - Country:US
Mailing Address - Phone:978-626-1105
Mailing Address - Fax:
Practice Address - Street 1:85 CONSTITUTION LN # 300A
Practice Address - Street 2:
Practice Address - City:DANVERS
Practice Address - State:MA
Practice Address - Zip Code:01923-3694
Practice Address - Country:US
Practice Address - Phone:978-626-1105
Practice Address - Fax:978-750-0766
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-03
Last Update Date:2023-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA8686103TC0700X, 103G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0000023532OtherBMC
MA1004745OtherNHP
MA042611055OtherTAX ID
MA1303287OtherMBHP
MAM18633OtherBCBS
MA1004745OtherFALLON
MA99618201OtherNETWORK HEALTH