Provider Demographics
NPI:1184369977
Name:CHRISTIAN BELLISSIMO, MSW,LCSW, RPT, LLC
Entity type:Organization
Organization Name:CHRISTIAN BELLISSIMO, MSW,LCSW, RPT, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTIAN
Authorized Official - Middle Name:
Authorized Official - Last Name:BELLISSIMO
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:732-609-7272
Mailing Address - Street 1:179 AVENUE AT THE CMN STE 103A
Mailing Address - Street 2:
Mailing Address - City:SHREWSBURY
Mailing Address - State:NJ
Mailing Address - Zip Code:07702-4804
Mailing Address - Country:US
Mailing Address - Phone:732-609-7272
Mailing Address - Fax:
Practice Address - Street 1:179 AVENUE AT THE CMN STE 103A
Practice Address - Street 2:
Practice Address - City:SHREWSBURY
Practice Address - State:NJ
Practice Address - Zip Code:07702-4804
Practice Address - Country:US
Practice Address - Phone:732-609-7272
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-05-05
Last Update Date:2022-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ44SC04658900OtherLICENSE