Provider Demographics
NPI:1588295844
Name:BELLONE, ELIZABETH (CCC-SLP, BCBA)
Entity type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:
Last Name:BELLONE
Suffix:
Gender:F
Credentials:CCC-SLP, BCBA
Other - Prefix:
Other - First Name:BETH
Other - Middle Name:
Other - Last Name:BELLONE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:CCC-SLP, BCBA
Mailing Address - Street 1:33 TURNPIKE RD
Mailing Address - Street 2:
Mailing Address - City:SOUTHBOROUGH
Mailing Address - State:MA
Mailing Address - Zip Code:01772-2108
Mailing Address - Country:US
Mailing Address - Phone:508-481-1015
Mailing Address - Fax:
Practice Address - Street 1:33 TURNPIKE RD
Practice Address - Street 2:
Practice Address - City:SOUTHBOROUGH
Practice Address - State:MA
Practice Address - Zip Code:01772-2108
Practice Address - Country:US
Practice Address - Phone:508-481-1015
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-01-27
Last Update Date:2020-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA328103K00000X
MA3782235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
No103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst