Provider Demographics
NPI:1689828865
Name:BELLISARIO, CATHLEEN KELLY (CCC/SLP)
Entity Type:Individual
Prefix:MRS
First Name:CATHLEEN
Middle Name:KELLY
Last Name:BELLISARIO
Suffix:
Gender:F
Credentials:CCC/SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25 VAN BUREN AVE
Mailing Address - Street 2:
Mailing Address - City:EAST GREENBUSH
Mailing Address - State:NY
Mailing Address - Zip Code:12061-2205
Mailing Address - Country:US
Mailing Address - Phone:518-477-2360
Mailing Address - Fax:
Practice Address - Street 1:25 VAN BUREN AVE
Practice Address - Street 2:
Practice Address - City:EAST GREENBUSH
Practice Address - State:NY
Practice Address - Zip Code:12061-2205
Practice Address - Country:US
Practice Address - Phone:518-477-2360
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-11-13
Last Update Date:2008-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY007647-1235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist