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NPI Code Detail

MEDICARE: MS. STACEY ANNE BELLONE LCSW

MEDICARE: MS. STACEY ANNE BELLONE 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
11041C0700XClinical Social Worker26682CA

General Provider Information

NPI Number : 1750410163
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. STACEY ANNE BELLONE LCSW
Provider Business Mailing Address
First Line : 5325 BRODER BLVD
Second Line :
City : DUBLIN
State : CA
Zip : 94568-3309
Country : US
Telephone Number : 925-551-6905
Fax Number : 925-551-6504
Provider Business Practice Location Address
First Line : 5325 BRODER BLVD
Second Line :
City : DUBLIN
State : CA
Zip : 94568-3309
Country : US
Telephone Number : 925-551-6905
Fax Number : 925-551-6504
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/02/2007
Last Update Date : 07/26/2012

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