Healthcare Provider Details

I. General information

NPI: 1154239663
Provider Name (Legal Business Name): JAASIEL BELLAMY
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/28/2026
Last Update Date: 08/28/2026
Certification Date: 08/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

256 WASHINGTON ST
MOUNT VERNON NY
10553-1052
US

IV. Provider business mailing address

256 WASHINGTON ST
MOUNT VERNON NY
10553-1052
US

V. Phone/Fax

Practice location:
  • Phone: 914-613-0700
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberP145459
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: