Provider Demographics
NPI:1962077131
Name:BEJ, NINA ALEXA (MT-BC)
Entity type:Individual
Prefix:
First Name:NINA
Middle Name:ALEXA
Last Name:BEJ
Suffix:
Gender:F
Credentials:MT-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1695 MAIN ST FL 400
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01103-1063
Mailing Address - Country:US
Mailing Address - Phone:413-739-5572
Mailing Address - Fax:
Practice Address - Street 1:1695 MAIN ST FL 400
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:MA
Practice Address - Zip Code:01103-1063
Practice Address - Country:US
Practice Address - Phone:413-739-5572
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-05-20
Last Update Date:2021-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
15101225A00000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
No225A00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMusic Therapist