Provider Demographics
NPI:1184630204
Name:DE BELLIS, MARLENE (LCSW)
Entity Type:Individual
Prefix:MS
First Name:MARLENE
Middle Name:
Last Name:DE BELLIS
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:MS
Other - First Name:MARLENE
Other - Middle Name:DE BELLIS
Other - Last Name:REILLY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW
Mailing Address - Street 1:9 MOTT AVE
Mailing Address - Street 2:FAMILY & CHILDREN'S AGENCY
Mailing Address - City:NORWALK
Mailing Address - State:CT
Mailing Address - Zip Code:06850-3330
Mailing Address - Country:US
Mailing Address - Phone:203-855-8765
Mailing Address - Fax:203-838-3325
Practice Address - Street 1:9 MOTT AVE
Practice Address - Street 2:FAMILY & CHILDREN'S AGENCY
Practice Address - City:NORWALK
Practice Address - State:CT
Practice Address - Zip Code:06850-3330
Practice Address - Country:US
Practice Address - Phone:203-855-8765
Practice Address - Fax:203-838-3325
Is Sole Proprietor?:No
Enumeration Date:2006-07-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0034101041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT140003410CT01OtherANTHEM PROV #