Provider Demographics
NPI:1205801768
Name:BELLEFONTAINE, JOAN MARIE (MFT)
Entity type:Individual
Prefix:MS
First Name:JOAN
Middle Name:MARIE
Last Name:BELLEFONTAINE
Suffix:
Gender:F
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:562 GLEN TRL
Mailing Address - Street 2:
Mailing Address - City:TOPANGA
Mailing Address - State:CA
Mailing Address - Zip Code:90290-3646
Mailing Address - Country:US
Mailing Address - Phone:818-771-7321
Mailing Address - Fax:
Practice Address - Street 1:13701 RIVERSIDE DR
Practice Address - Street 2:STE 418
Practice Address - City:SHERMAN OAKS
Practice Address - State:CA
Practice Address - Zip Code:91423-2430
Practice Address - Country:US
Practice Address - Phone:818-771-7321
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-02-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC33947106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist