Provider Demographics
NPI:1871957209
Name:KATZ BELLANI, MARISSA
Entity type:Individual
Prefix:
First Name:MARISSA
Middle Name:
Last Name:KATZ BELLANI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1221 KAPIOLANI BLVD PH 50
Mailing Address - Street 2:
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96814-3518
Mailing Address - Country:US
Mailing Address - Phone:808-260-9893
Mailing Address - Fax:808-748-0433
Practice Address - Street 1:1221 KAPIOLANI BLVD PH 50
Practice Address - Street 2:
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96814-3518
Practice Address - Country:US
Practice Address - Phone:808-260-9893
Practice Address - Fax:808-748-0433
Is Sole Proprietor?:No
Enumeration Date:2016-04-12
Last Update Date:2023-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101Y00000X
MA101YM0800X
HIMHC-851101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA1004745OtherNHP
MA99618201OtherNETWORK HEALTH
MA0000023532OtherBMC
MA1303287OtherMBHP
MA1004745OtherFALLON
MAM18633OtherBCBS
MA042611055OtherTAX ID