Provider Demographics
NPI: | 1316976400 |
---|---|
Name: | MAYHEW-BELATSKI, BARBARA J (LICSW,LADC) |
Entity type: | Individual |
Prefix: | |
First Name: | BARBARA |
Middle Name: | J |
Last Name: | MAYHEW-BELATSKI |
Suffix: | |
Gender: | |
Credentials: | LICSW,LADC |
Other - Prefix: | |
Other - First Name: | |
Other - Middle Name: | |
Other - Last Name: | |
Other - Suffix: | |
Other - Last Name Type: | |
Other - Credentials: | |
Mailing Address - Street 1: | 102 S WINOOSKI AVE |
Mailing Address - Street 2: | |
Mailing Address - City: | BURLINGTON |
Mailing Address - State: | VT |
Mailing Address - Zip Code: | 05401-7406 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 802-488-6920 |
Mailing Address - Fax: | |
Practice Address - Street 1: | 855 PINE ST |
Practice Address - Street 2: | |
Practice Address - City: | BURLINGTON |
Practice Address - State: | VT |
Practice Address - Zip Code: | 05401-4924 |
Practice Address - Country: | US |
Practice Address - Phone: | 802-865-6148 |
Practice Address - Fax: | |
Is Sole Proprietor?: | No |
Enumeration Date: | 2006-07-01 |
Last Update Date: | 2025-04-29 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
VT | 151-0125735 | 101YA0400X |
VT | 089-0000342 | 1041C0700X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization |
---|---|---|---|---|
Yes | 1041C0700X | Behavioral Health & Social Service Providers | Social Worker | Clinical |
No | 101YA0400X | Behavioral Health & Social Service Providers | Counselor | Addiction (Substance Use Disorder) |
Provider Identifiers
State | Identifier ID | ID Type | Issuer |
---|---|---|---|
VT | 1007284 | Medicaid | |
VT | 1007284 | Medicaid |