Provider Demographics
NPI:1073713061
Name:BELLETIERE, DANA MARIE (LICSW, MSED)
Entity Type:Individual
Prefix:
First Name:DANA
Middle Name:MARIE
Last Name:BELLETIERE
Suffix:
Gender:F
Credentials:LICSW, MSED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19 IOWA AVE
Mailing Address - Street 2:
Mailing Address - City:ABSECON
Mailing Address - State:NJ
Mailing Address - Zip Code:08201-2606
Mailing Address - Country:US
Mailing Address - Phone:484-947-1071
Mailing Address - Fax:
Practice Address - Street 1:19 IOWA AVE
Practice Address - Street 2:
Practice Address - City:ABSECON
Practice Address - State:NJ
Practice Address - Zip Code:08201-2606
Practice Address - Country:US
Practice Address - Phone:484-947-1071
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-19
Last Update Date:2023-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH19931041C0700X
44SC060727001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty