Provider Demographics
NPI:1952433195
Name:BELCHER, PHYLLIS LOUISE (PSYD)
Entity Type:Individual
Prefix:DR
First Name:PHYLLIS
Middle Name:LOUISE
Last Name:BELCHER
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:70 PARKSIDE AVE
Mailing Address - Street 2:
Mailing Address - City:BRAINTREE
Mailing Address - State:MA
Mailing Address - Zip Code:02184-3102
Mailing Address - Country:US
Mailing Address - Phone:781-843-4090
Mailing Address - Fax:781-843-4090
Practice Address - Street 1:70 PARKSIDE AVE
Practice Address - Street 2:
Practice Address - City:BRAINTREE
Practice Address - State:MA
Practice Address - Zip Code:02184-3102
Practice Address - Country:US
Practice Address - Phone:781-843-4090
Practice Address - Fax:781-843-4090
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA7182103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA1011280OtherBEACON HEALTH FOR FCHP
MAW05589OtherBCBS
MA0526061Medicaid
MAW50191Medicare ID - Type Unspecified