Provider Demographics
NPI:1275591703
Name:BELANGER, MARIE CERVELLERO (MSN, FNP- PMHNP- BC)
Entity type:Individual
Prefix:MS
First Name:MARIE
Middle Name:CERVELLERO
Last Name:BELANGER
Suffix:
Gender:
Credentials:MSN, FNP- PMHNP- BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:2261 MARKET ST STE 10222
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94114-1612
Mailing Address - Country:US
Mailing Address - Phone:415-360-3348
Mailing Address - Fax:571-376-6798
Practice Address - Street 1:3064 WAKE FOREST RD # 1271
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27609-7844
Practice Address - Country:US
Practice Address - Phone:415-360-3348
Practice Address - Fax:571-376-6798
Is Sole Proprietor?:No
Enumeration Date:2006-05-03
Last Update Date:2025-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC201425363LF0000X, 363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC7000334Medicaid
NCP47484Medicare ID - Type Unspecified
NC7000334Medicaid