Provider Demographics
NPI:1265759617
Name:BELHUMEUR, LISETTE (MED)
Entity type:Individual
Prefix:
First Name:LISETTE
Middle Name:
Last Name:BELHUMEUR
Suffix:
Gender:F
Credentials:MED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:87 WASHINGTON ST
Mailing Address - Street 2:
Mailing Address - City:CONWAY
Mailing Address - State:NH
Mailing Address - Zip Code:03818-6044
Mailing Address - Country:US
Mailing Address - Phone:603-447-4356
Mailing Address - Fax:603-447-4358
Practice Address - Street 1:71 HOBBS ST
Practice Address - Street 2:SUITE 102
Practice Address - City:CONWAY
Practice Address - State:NH
Practice Address - Zip Code:03818-8109
Practice Address - Country:US
Practice Address - Phone:603-447-4356
Practice Address - Fax:603-447-4358
Is Sole Proprietor?:Yes
Enumeration Date:2010-04-26
Last Update Date:2010-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist