Provider Demographics
NPI:1124350822
Name:BELANGER, DENISE MICHELLE (RN, NP, PMHNP)
Entity type:Individual
Prefix:DR
First Name:DENISE
Middle Name:MICHELLE
Last Name:BELANGER
Suffix:
Gender:F
Credentials:RN, NP, PMHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:147 ROSS ST APT 1
Mailing Address - Street 2:
Mailing Address - City:SAN RAFAEL
Mailing Address - State:CA
Mailing Address - Zip Code:94901-4958
Mailing Address - Country:US
Mailing Address - Phone:415-578-0343
Mailing Address - Fax:
Practice Address - Street 1:147 ROSS ST APT 1
Practice Address - Street 2:
Practice Address - City:SAN RAFAEL
Practice Address - State:CA
Practice Address - Zip Code:94901-4958
Practice Address - Country:US
Practice Address - Phone:415-578-0343
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-02-04
Last Update Date:2022-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA742135163W00000X
CA574163WP0808X
CA23844363L00000X, 363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163W00000XNursing Service ProvidersRegistered Nurse
No163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental Health
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner