1184630204 NPI number — MS. MARLENE DE BELLIS LCSW

Table of content: MS. MARLENE DE BELLIS LCSW (NPI 1184630204)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1184630204 NPI number — MS. MARLENE DE BELLIS LCSW

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
DE BELLIS
Provider First Name:
MARLENE
Provider Middle Name:
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
LCSW
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
REILLY
Provider Other First Name:
MARLENE
Provider Other Middle Name:
DE BELLIS
Provider Other Name Prefix Text:
MS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
LCSW
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1184630204
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
9 MOTT AVE
Provider Second Line Business Mailing Address:
FAMILY & CHILDREN'S AGENCY
Provider Business Mailing Address City Name:
NORWALK
Provider Business Mailing Address State Name:
CT
Provider Business Mailing Address Postal Code:
06850-3330
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
203-855-8765
Provider Business Mailing Address Fax Number:
203-838-3325

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
9 MOTT AVE
Provider Second Line Business Practice Location Address:
FAMILY & CHILDREN'S AGENCY
Provider Business Practice Location Address City Name:
NORWALK
Provider Business Practice Location Address State Name:
CT
Provider Business Practice Location Address Postal Code:
06850-3330
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
203-855-8765
Provider Business Practice Location Address Fax Number:
203-838-3325
Provider Enumeration Date:
07/31/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 1041C0700X , with the licence number:  003410 , registered in the state of CT ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 140003410CT01 . This is a "ANTHEM PROV #" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".




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