Provider Demographics
NPI:1831486406
Name:BELLISSIMO, CHRISTIAN THOMAS (LCSW, RPT)
Entity Type:Individual
Prefix:MR
First Name:CHRISTIAN
Middle Name:THOMAS
Last Name:BELLISSIMO
Suffix:
Gender:M
Credentials:LCSW, RPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 7546
Mailing Address - Street 2:
Mailing Address - City:SHREWSBURY
Mailing Address - State:NJ
Mailing Address - Zip Code:07702-7546
Mailing Address - Country:US
Mailing Address - Phone:732-609-7272
Mailing Address - Fax:
Practice Address - Street 1:1 MAIN ST
Practice Address - Street 2:SUITE 111
Practice Address - City:EATONTOWN
Practice Address - State:NJ
Practice Address - Zip Code:07724-3450
Practice Address - Country:US
Practice Address - Phone:732-609-7272
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-07-05
Last Update Date:2011-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJSC046589001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical