Provider Demographics
NPI:1073341434
Name:BELLOCQ, SUSAN (DOULA)
Entity type:Individual
Prefix:MRS
First Name:SUSAN
Middle Name:
Last Name:BELLOCQ
Suffix:
Gender:F
Credentials:DOULA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8811 BERGENLINE AVE APT 12
Mailing Address - Street 2:
Mailing Address - City:NORTH BERGEN
Mailing Address - State:NJ
Mailing Address - Zip Code:07047-5263
Mailing Address - Country:US
Mailing Address - Phone:201-456-5824
Mailing Address - Fax:
Practice Address - Street 1:8811 BERGENLINE AVE APT 12
Practice Address - Street 2:
Practice Address - City:NORTH BERGEN
Practice Address - State:NJ
Practice Address - Zip Code:07047-5263
Practice Address - Country:US
Practice Address - Phone:201-456-5824
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-07-25
Last Update Date:2024-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ374J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374J00000XNursing Service Related ProvidersDoula