MEDICARE: CHRISTA WELCH BELLANCA LCSW-C

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker	22987	MD

General Provider Information

NPI Number	:	1669118410
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHRISTA WELCH BELLANCA LCSW-C

Provider Business Mailing Address
First Line	:	3303 OAK DR
Second Line	:
City	:	EDGEWATER
State	:	MD
Zip	:	21037-3035
Country	:	US
Telephone Number	:	301-615-1117
Fax Number	:

Provider Business Practice Location Address
First Line	:	2009 TIDEWATER COLONY DR STE B
Second Line	:
City	:	ANNAPOLIS
State	:	MD
Zip	:	21401-2107
Country	:	US
Telephone Number	:	301-615-1117
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/05/2022
Last Update Date	:	03/01/2024

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