Provider Demographics
NPI:1013013994
Name:BELLIN, JONATHAN DAVID (LCSW)
Entity Type:Individual
Prefix:
First Name:JONATHAN
Middle Name:DAVID
Last Name:BELLIN
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:500 W 235TH ST
Mailing Address - Street 2:APT 2C
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10463-1827
Mailing Address - Country:US
Mailing Address - Phone:718-702-0697
Mailing Address - Fax:
Practice Address - Street 1:3701 HENRY HUDSON PKWY
Practice Address - Street 2:SUITE 1C
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10463-1521
Practice Address - Country:US
Practice Address - Phone:718-702-0697
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-16
Last Update Date:2011-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY079153-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical