Healthcare Provider Details

I. General information

NPI: 1033089743
Provider Name (Legal Business Name): ADDISON M BELCAMINO LMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/07/2025
Last Update Date: 11/07/2025
Certification Date: 11/07/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

140 N FRONTAGE RD
MANSFIELD CENTER CT
06250-1648
US

IV. Provider business mailing address

218 WATERHOLE RD
COLCHESTER CT
06415-2357
US

V. Phone/Fax

Practice location:
  • Phone: 860-456-2261
  • Fax: 860-450-1357
Mailing address:
  • Phone: 860-456-2261
  • Fax: 860-450-1357

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number11455
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: