Provider Demographics
NPI:1346749967
Name:BELLAVIA, ANGELINA MARIE (MHC-LP)
Entity Type:Individual
Prefix:MS
First Name:ANGELINA
Middle Name:MARIE
Last Name:BELLAVIA
Suffix:
Gender:F
Credentials:MHC-LP
Other - Prefix:
Other - First Name:ANGELINA
Other - Middle Name:
Other - Last Name:MENDOLIA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:9107 153RD AVE
Mailing Address - Street 2:
Mailing Address - City:HOWARD BEACH
Mailing Address - State:NY
Mailing Address - Zip Code:11414-1603
Mailing Address - Country:US
Mailing Address - Phone:631-831-3242
Mailing Address - Fax:
Practice Address - Street 1:10819 ROCKAWAY BLVD
Practice Address - Street 2:
Practice Address - City:SOUTH OZONE PARK
Practice Address - State:NY
Practice Address - Zip Code:11420-1034
Practice Address - Country:US
Practice Address - Phone:718-845-2620
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-02-09
Last Update Date:2022-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYP03594101YM0800X
NY008691101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health