Provider Demographics
NPI:1912542978
Name:BELACY, GAETHANE THERESE
Entity Type:Individual
Prefix:
First Name:GAETHANE
Middle Name:THERESE
Last Name:BELACY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:GAETHANE
Other - Middle Name:THERESE
Other - Last Name:VALME
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:90 PLYMOUTH DR APT C
Mailing Address - Street 2:
Mailing Address - City:NORWOOD
Mailing Address - State:MA
Mailing Address - Zip Code:02062-5441
Mailing Address - Country:US
Mailing Address - Phone:617-851-1041
Mailing Address - Fax:
Practice Address - Street 1:90 PLYMOUTH DR APT C
Practice Address - Street 2:
Practice Address - City:NORWOOD
Practice Address - State:MA
Practice Address - Zip Code:02062-5441
Practice Address - Country:US
Practice Address - Phone:617-851-1041
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-11-14
Last Update Date:2019-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife