Provider Demographics
NPI:1750410163
Name:BELLONE, STACEY ANNE (LCSW)
Entity type:Individual
Prefix:MS
First Name:STACEY
Middle Name:ANNE
Last Name:BELLONE
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5325 BRODER BLVD
Mailing Address - Street 2:
Mailing Address - City:DUBLIN
Mailing Address - State:CA
Mailing Address - Zip Code:94568-3309
Mailing Address - Country:US
Mailing Address - Phone:925-551-6905
Mailing Address - Fax:925-551-6504
Practice Address - Street 1:5325 BRODER BLVD
Practice Address - Street 2:
Practice Address - City:DUBLIN
Practice Address - State:CA
Practice Address - Zip Code:94568-3309
Practice Address - Country:US
Practice Address - Phone:925-551-6905
Practice Address - Fax:925-551-6504
Is Sole Proprietor?:No
Enumeration Date:2007-03-02
Last Update Date:2012-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA266821041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical