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ANCILLARY PRACTITIONER DATA FORM: BEHAVIORAL HEALTH/SUBSTANCE USE DISORDER/ CLINIC Please email to AHCBehavioralHealth×tuftshealth.com or fax to 617.673.0909. Please review Behavioral Health/Substance

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How to fill out ancillary practitioner data formbehavioral

01

To fill out the ancillary practitioner data formbehavioral, follow these points:

02

Start by entering the practitioner's personal information, such as name, address, and contact details.

03

Provide the practitioner's professional qualifications, including degrees, certifications, and licenses.

04

Indicate the practitioner's areas of expertise or specialization.

05

Describe the practitioner's professional experience, including previous positions held and length of practice.

06

Mention any relevant memberships or affiliations the practitioner has.

07

Provide references or testimonials from clients or colleagues, if available.

08

Submit any supporting documents, such as a curriculum vitae or portfolio, if required.

09

Review the filled form for accuracy and completeness before submitting it.

Who needs ancillary practitioner data formbehavioral?

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Ancillary practitioner data formbehavioral is needed by healthcare organizations, hospitals, clinics, or any entity that requires information about ancillary practitioners for credentialing or verifying their qualifications and expertise.

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