MEDICARE: DABNEY BELCASTRO LCSW

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	101YM0800X	Mental Health Counselor	0904010132	VA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	0904010132	OTHER	VA	STATE ISSUED LICENSE NUMBER

General Provider Information

NPI Number	:	1699251850
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DABNEY BELCASTRO LCSW

Provider Business Mailing Address
First Line	:	8158 HILLIS WAY
Second Line	:
City	:	MECHANICSVILLE
State	:	VA
Zip	:	23111-5930
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	7489 RIGHT FLANK RD STE 330
Second Line	:
City	:	MECHANICSVILLE
State	:	VA
Zip	:	23116-3845
Country	:	US
Telephone Number	:	804-398-8401
Fax Number	:

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

Provider Enumeration Date	:	07/11/2018
Last Update Date	:	07/11/2018

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