Provider Demographics
NPI:1326473026
Name:BELOTTI, MARTINA R (MA)
Entity Type:Individual
Prefix:MS
First Name:MARTINA
Middle Name:R
Last Name:BELOTTI
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:107 AVENIDA PRIMICERIA
Mailing Address - Street 2:
Mailing Address - City:MARATHON
Mailing Address - State:FL
Mailing Address - Zip Code:33050-2526
Mailing Address - Country:US
Mailing Address - Phone:305-743-6215
Mailing Address - Fax:305-743-8394
Practice Address - Street 1:107 AVENIDA PRIMICERIA
Practice Address - Street 2:
Practice Address - City:MARATHON
Practice Address - State:FL
Practice Address - Zip Code:33050-2526
Practice Address - Country:US
Practice Address - Phone:305-743-6215
Practice Address - Fax:305-743-8394
Is Sole Proprietor?:Yes
Enumeration Date:2013-09-12
Last Update Date:2013-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor