Provider Demographics
NPI:1275591703
Name:BELANGER, MARIE CERVELLERO (MSN, FNP- PMHNP- BC)
Entity Type:Individual
Prefix:MS
First Name:MARIE
Middle Name:CERVELLERO
Last Name:BELANGER
Suffix:
Gender:F
Credentials:MSN, FNP- PMHNP- BC
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Other - Credentials:
Mailing Address - Street 1:200 TARPON TRAIL
Mailing Address - Street 2:COASTAL CAROLINA NEUROPSYCHIATRIC CENTER PA
Mailing Address - City:JACKSONVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28546-5226
Mailing Address - Country:US
Mailing Address - Phone:910-938-1114
Mailing Address - Fax:910-938-1118
Practice Address - Street 1:200 TARPON TRAIL
Practice Address - Street 2:COASTAL CAROLINA NEUROPSYCHIATRIC CENTER PA
Practice Address - City:JACKSONVILLE
Practice Address - State:NC
Practice Address - Zip Code:28546-5226
Practice Address - Country:US
Practice Address - Phone:910-938-1114
Practice Address - Fax:910-938-1118
Is Sole Proprietor?:No
Enumeration Date:2006-05-03
Last Update Date:2013-04-04
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NC201425363LP0808X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC7000334Medicaid
NCP47484Medicare ID - Type Unspecified
NC7000334Medicaid