Provider Demographics
NPI:1912362112
Name:BELLOMIO, BROOKE ANN (PSYD)
Entity Type:Individual
Prefix:MRS
First Name:BROOKE
Middle Name:ANN
Last Name:BELLOMIO
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:BROOKE
Other - Middle Name:
Other - Last Name:BARNETT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2558 ROOSEVELT ST STE 203
Mailing Address - Street 2:
Mailing Address - City:CARLSBAD
Mailing Address - State:CA
Mailing Address - Zip Code:92008-1673
Mailing Address - Country:US
Mailing Address - Phone:760-410-8239
Mailing Address - Fax:
Practice Address - Street 1:2558 ROOSEVELT ST. SUITE 203
Practice Address - Street 2:
Practice Address - City:CARLSBAD
Practice Address - State:CA
Practice Address - Zip Code:92008
Practice Address - Country:US
Practice Address - Phone:760-410-8239
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-12-15
Last Update Date:2018-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY27886103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical