Provider Demographics
NPI:1073286795
Name:BELLAGAMBA, DENISE ANNETTE
Entity Type:Individual
Prefix:
First Name:DENISE
Middle Name:ANNETTE
Last Name:BELLAGAMBA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:DENISE
Other - Middle Name:ANNETTE
Other - Last Name:DRILLON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMHC
Mailing Address - Street 1:1117 E RICHWOODS BLVD
Mailing Address - Street 2:
Mailing Address - City:PEORIA
Mailing Address - State:IL
Mailing Address - Zip Code:61603-1539
Mailing Address - Country:US
Mailing Address - Phone:309-437-8491
Mailing Address - Fax:
Practice Address - Street 1:431 46TH ST W
Practice Address - Street 2:
Practice Address - City:PALMETTO
Practice Address - State:FL
Practice Address - Zip Code:34221-9722
Practice Address - Country:US
Practice Address - Phone:309-437-8491
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-07-28
Last Update Date:2021-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH8107101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health