Provider Demographics
NPI:1467296343
Name:RENGIFO GARCIA, BELLA L
Entity type:Individual
Prefix:MISS
First Name:BELLA
Middle Name:L
Last Name:RENGIFO GARCIA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:656 FARM RD
Mailing Address - Street 2:
Mailing Address - City:MARLBOROUGH
Mailing Address - State:MA
Mailing Address - Zip Code:01752-2764
Mailing Address - Country:US
Mailing Address - Phone:508-424-8454
Mailing Address - Fax:
Practice Address - Street 1:656 FARM RD
Practice Address - Street 2:
Practice Address - City:MARLBOROUGH
Practice Address - State:MA
Practice Address - Zip Code:01752-2764
Practice Address - Country:US
Practice Address - Phone:508-424-8454
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-06-24
Last Update Date:2024-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker