Provider Demographics
NPI:1912350018
Name:BELLEARD, JILLIAN MARIE DERUSCIO (LCPC)
Entity Type:Individual
Prefix:MS
First Name:JILLIAN
Middle Name:MARIE DERUSCIO
Last Name:BELLEARD
Suffix:
Gender:F
Credentials:LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:460 MAIN ST STE 2
Mailing Address - Street 2:
Mailing Address - City:SPRINGVALE
Mailing Address - State:ME
Mailing Address - Zip Code:04083-1874
Mailing Address - Country:US
Mailing Address - Phone:207-502-5896
Mailing Address - Fax:
Practice Address - Street 1:460 MAIN ST
Practice Address - Street 2:
Practice Address - City:SPRINGVALE
Practice Address - State:ME
Practice Address - Zip Code:04083-1874
Practice Address - Country:US
Practice Address - Phone:518-368-5465
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-07-13
Last Update Date:2020-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MECC5044101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional