Provider Demographics
NPI:1932680980
Name:BELOTE, LARISA
Entity Type:Individual
Prefix:
First Name:LARISA
Middle Name:
Last Name:BELOTE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8 MITCHELL CT
Mailing Address - Street 2:
Mailing Address - City:MARLBORO
Mailing Address - State:NJ
Mailing Address - Zip Code:07746-2217
Mailing Address - Country:US
Mailing Address - Phone:732-996-6963
Mailing Address - Fax:
Practice Address - Street 1:4 BRIDGE PLAZA DR
Practice Address - Street 2:
Practice Address - City:MANALAPAN
Practice Address - State:NJ
Practice Address - Zip Code:07726-1746
Practice Address - Country:US
Practice Address - Phone:732-490-5770
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-28
Last Update Date:2018-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133N00000XDietary & Nutritional Service ProvidersNutritionist
No101Y00000XBehavioral Health & Social Service ProvidersCounselor