Provider Demographics
NPI:1275731168
Name:BELLAVITA, MICHELE L (MS SCHOOL PSYCHOLOGY)
Entity Type:Individual
Prefix:MS
First Name:MICHELE
Middle Name:L
Last Name:BELLAVITA
Suffix:
Gender:F
Credentials:MS SCHOOL PSYCHOLOGY
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:120 96TH ST APT 6L
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11209-7518
Mailing Address - Country:US
Mailing Address - Phone:718-680-2915
Mailing Address - Fax:
Practice Address - Street 1:300 FLATBUSH AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11217-2812
Practice Address - Country:US
Practice Address - Phone:718-622-2000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health