Provider Demographics
NPI:1821336942
Name:JAMIE BELLENOIT, PHD, LMFT, LLC
Entity Type:Organization
Organization Name:JAMIE BELLENOIT, PHD, LMFT, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MARRIAGE AND FAMILY THERAPIST
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMIE
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:BELLENOIT
Authorized Official - Suffix:
Authorized Official - Credentials:LMFT
Authorized Official - Phone:860-965-1640
Mailing Address - Street 1:805 FARMINGTON AVE
Mailing Address - Street 2:OFFICE 1
Mailing Address - City:WEST HARTFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06119-1670
Mailing Address - Country:US
Mailing Address - Phone:860-965-1640
Mailing Address - Fax:
Practice Address - Street 1:805 FARMINGTON AVE
Practice Address - Street 2:OFFICE 1
Practice Address - City:WEST HARTFORD
Practice Address - State:CT
Practice Address - Zip Code:06119-1670
Practice Address - Country:US
Practice Address - Phone:860-965-1640
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-01-24
Last Update Date:2013-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT1267251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health