Healthcare Provider Details

I. General information

NPI: 1104185248
Provider Name (Legal Business Name): HOLLY M VANBELLE MSW, LCSW, CAADC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/10/2012
Last Update Date: 11/03/2020
Certification Date: 11/03/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

501 N LANSDOWNE AVE
DREXEL HILL PA
19026-1114
US

IV. Provider business mailing address

501 N LANSDOWNE AVE
DREXEL HILL PA
19026-1114
US

V. Phone/Fax

Practice location:
  • Phone: 610-394-1700
  • Fax: 610-394-1755
Mailing address:
  • Phone: 610-394-1700
  • Fax: 610-394-1755

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number11970
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberCW021297
License Number StatePA
# 3
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: