Provider Demographics
NPI:1730253394
Name:BEZANSON, MARK (LICSW)
Entity type:Individual
Prefix:
First Name:MARK
Middle Name:
Last Name:BEZANSON
Suffix:
Gender:M
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5 MARKET SQ STE 103
Mailing Address - Street 2:
Mailing Address - City:AMESBURY
Mailing Address - State:MA
Mailing Address - Zip Code:01913-2440
Mailing Address - Country:US
Mailing Address - Phone:978-904-1075
Mailing Address - Fax:
Practice Address - Street 1:5 MARKET SQ STE 103
Practice Address - Street 2:
Practice Address - City:AMESBURY
Practice Address - State:MA
Practice Address - Zip Code:01913-2440
Practice Address - Country:US
Practice Address - Phone:978-904-1075
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-17
Last Update Date:2017-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA10194121041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH7706655Y0NH01OtherBHN
NH99003227Medicaid
NHNH3227Medicare ID - Type Unspecified