Provider Demographics
NPI:1255466520
Name:BELLUSCIO, DALE ROBIN (LISW-CP)
Entity Type:Individual
Prefix:
First Name:DALE
Middle Name:ROBIN
Last Name:BELLUSCIO
Suffix:
Gender:F
Credentials:LISW-CP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:31 LARAMEE ST
Mailing Address - Street 2:
Mailing Address - City:WEST WARWICK
Mailing Address - State:RI
Mailing Address - Zip Code:02893-5134
Mailing Address - Country:US
Mailing Address - Phone:401-744-0877
Mailing Address - Fax:401-467-3917
Practice Address - Street 1:597 OLD MOUNT HOLLY RD STE 300
Practice Address - Street 2:
Practice Address - City:GOOSE CREEK
Practice Address - State:SC
Practice Address - Zip Code:29445-2832
Practice Address - Country:US
Practice Address - Phone:843-501-1099
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-23
Last Update Date:2023-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC159381041C0700X
RIISW018871041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
RIDB61395Medicaid