Provider Demographics
NPI:1962523522
Name:BELLOTTI, ROXANNE LENORA BERRY (LCSW)
Entity type:Individual
Prefix:MS
First Name:ROXANNE
Middle Name:LENORA BERRY
Last Name:BELLOTTI
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:613 BAYWOOD RD
Mailing Address - Street 2:
Mailing Address - City:ALAMEDA
Mailing Address - State:CA
Mailing Address - Zip Code:94502-6603
Mailing Address - Country:US
Mailing Address - Phone:510-289-5003
Mailing Address - Fax:
Practice Address - Street 1:2151 SALVIO ST.
Practice Address - Street 2:SUITE 301
Practice Address - City:CONCORD, CA
Practice Address - State:CA
Practice Address - Zip Code:94520-2451
Practice Address - Country:US
Practice Address - Phone:925-383-2154
Practice Address - Fax:925-887-0841
Is Sole Proprietor?:No
Enumeration Date:2007-04-02
Last Update Date:2022-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAASW 16156101YM0800X
CALCSW248971041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health