Provider Demographics
NPI:1639832314
Name:BELLAMY, KATHY DENISE
Entity Type:Individual
Prefix:
First Name:KATHY
Middle Name:DENISE
Last Name:BELLAMY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4520 BUTTONBUSH DR
Mailing Address - Street 2:
Mailing Address - City:TITUSVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32796-1487
Mailing Address - Country:US
Mailing Address - Phone:413-686-5239
Mailing Address - Fax:
Practice Address - Street 1:4520 BUTTONBUSH DR
Practice Address - Street 2:
Practice Address - City:TITUSVILLE
Practice Address - State:FL
Practice Address - Zip Code:32796-1487
Practice Address - Country:US
Practice Address - Phone:413-686-5239
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-10-19
Last Update Date:2021-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health