Provider Demographics
NPI:1295764694
Name:BELLOWS, AIMEE W (PHD)
Entity type:Individual
Prefix:
First Name:AIMEE
Middle Name:W
Last Name:BELLOWS
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 1:9 WARE ST
Mailing Address - Street 2:APT 7
Mailing Address - City:CAMBRIDGE
Mailing Address - State:MA
Mailing Address - Zip Code:02138-4012
Mailing Address - Country:US
Mailing Address - Phone:617-876-6679
Mailing Address - Fax:
Practice Address - Street 1:9 WARE ST
Practice Address - Street 2:APT 7
Practice Address - City:CAMBRIDGE
Practice Address - State:MA
Practice Address - Zip Code:02138-4012
Practice Address - Country:US
Practice Address - Phone:617-876-6679
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIPS00173103TC0700X
MA1937103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
RI30004-5OtherBLUE CROSS
RI61-15762OtherUNITED BEHAVIORAL HEALTH
RIAB03775Medicaid
RI407462OtherBLUE CHIP