Provider Demographics
NPI:1679108542
Name:BELL-BRANTLEY, OLIVIA JUNE (LPCA)
Entity Type:Individual
Prefix:
First Name:OLIVIA
Middle Name:JUNE
Last Name:BELL-BRANTLEY
Suffix:
Gender:F
Credentials:LPCA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:225 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:BRISTOL
Mailing Address - State:CT
Mailing Address - Zip Code:06010-4926
Mailing Address - Country:US
Mailing Address - Phone:203-627-9120
Mailing Address - Fax:
Practice Address - Street 1:225 N MAIN ST
Practice Address - Street 2:
Practice Address - City:BRISTOL
Practice Address - State:CT
Practice Address - Zip Code:06010-4926
Practice Address - Country:US
Practice Address - Phone:203-627-9120
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-03-11
Last Update Date:2020-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT46.004232101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional