Healthcare Provider Details

I. General information

NPI: 1831606862
Provider Name (Legal Business Name): MIKE BELLAMY COUNSELING LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/28/2017
Last Update Date: 01/10/2020
Certification Date: 01/10/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

297 KINDERKAMACK RD STE 212
ORADELL NJ
07649-1535
US

IV. Provider business mailing address

70 WILLOW AVE
HACKENSACK NJ
07601-3001
US

V. Phone/Fax

Practice location:
  • Phone: 201-543-9587
  • Fax:
Mailing address:
  • Phone: 201-543-9587
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number44SC05424200
License Number StateNJ

VIII. Authorized Official

Name: MIKE BELLAMY
Title or Position: PRINCIPAL
Credential: LCSW
Phone: 201-543-9587