Samuel J Bellotte

Primary specialty

Early Intervention Provider AgencyTaxonomy code 252Y00000X

License

UD001455404001 Issued in WV

Practice address

159 Kramer Dr
Clarksburg, WV 26301-4264

Phone

(304) 709-2209

NPI assigned

Aug 23, 2024

Last updated

Oct 19, 2024By the provider in NPPES

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1724371200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1729296000000",
    "number": "1043043060",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "159 KRAMER DR",
            "city": "CLARKSBURG",
            "state": "WV",
            "postal_code": "263014264",
            "telephone_number": "304-709-2209"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "159 KRAMER DR",
            "city": "CLARKSBURG",
            "state": "WV",
            "postal_code": "263014264",
            "telephone_number": "304-709-2209"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BELLOTTE",
        "first_name": "SAMUEL",
        "middle_name": "J",
        "name_prefix": "Mr.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2024-08-23",
        "last_updated": "2024-10-19",
        "certification_date": "2024-10-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "252Y00000X",
            "taxonomy_group": "",
            "desc": "Early Intervention Provider Agency",
            "state": "WV",
            "license": "UD001455404001",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Cassandra Beatty
• Lloyd Andrew Bee
• Shannon Marie Beish Jones, PSY.D.
• Terri Leanne Belcher, PA-C
• Billiee Bell
• Benchmark Therapy, Inc
• Carol Louise Bennett
• Darral N Bennett Jr., LICSW
• Debra Dawn Bennett, RN
• Hollie Bennett

• Early Intervention Provider Agency in Clarksburg, WV
• Providers in Clarksburg, WV by specialty
• Early Intervention Provider Agency in West Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 19, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.