Provider Demographics
NPI:1851448864
Name:BELOZERSKY, IRENE (LICSW)
Entity type:Individual
Prefix:MRS
First Name:IRENE
Middle Name:
Last Name:BELOZERSKY
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:500 WASHINGTON ST
Mailing Address - Street 2:
Mailing Address - City:BROOKLINE
Mailing Address - State:MA
Mailing Address - Zip Code:02446-4516
Mailing Address - Country:US
Mailing Address - Phone:617-457-8582
Mailing Address - Fax:617-988-6262
Practice Address - Street 1:124 HARVARD ST
Practice Address - Street 2:SUITE 2B
Practice Address - City:BROOKLINE
Practice Address - State:MA
Practice Address - Zip Code:02446-6478
Practice Address - Country:US
Practice Address - Phone:617-457-8582
Practice Address - Fax:617-988-6262
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-04
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA10188201041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA1853902Medicaid
MA1892401Medicaid
MA340924OtherMAGELLAN
MABCBSMAOtherBEPO5836
MA112919OtherUBH
MA1892401Medicaid
MA1853902Medicaid