Provider Demographics
NPI:1598003352
Name:BELLANCA, ANDREW GORDON (LGSW)
Entity Type:Individual
Prefix:
First Name:ANDREW
Middle Name:GORDON
Last Name:BELLANCA
Suffix:
Gender:M
Credentials:LGSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6918 RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:ROSEDALE
Mailing Address - State:MD
Mailing Address - Zip Code:21237-3854
Mailing Address - Country:US
Mailing Address - Phone:443-442-1568
Mailing Address - Fax:443-442-1569
Practice Address - Street 1:6918 RIDGE RD
Practice Address - Street 2:
Practice Address - City:ROSEDALE
Practice Address - State:MD
Practice Address - Zip Code:21237-3854
Practice Address - Country:US
Practice Address - Phone:443-442-1568
Practice Address - Fax:443-442-1569
Is Sole Proprietor?:Yes
Enumeration Date:2013-01-29
Last Update Date:2013-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD16867104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker