Provider Demographics
NPI:1578353603
Name:BELLAGAMBA, GABRIEL (NCSP)
Entity type:Individual
Prefix:MR
First Name:GABRIEL
Middle Name:
Last Name:BELLAGAMBA
Suffix:
Gender:M
Credentials:NCSP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1901 RAINBOW DR
Mailing Address - Street 2:
Mailing Address - City:SILVER SPRING
Mailing Address - State:MD
Mailing Address - Zip Code:20905-4242
Mailing Address - Country:US
Mailing Address - Phone:301-288-8344
Mailing Address - Fax:
Practice Address - Street 1:1901 RAINBOW DR
Practice Address - Street 2:
Practice Address - City:SILVER SPRING
Practice Address - State:MD
Practice Address - Zip Code:20905-4242
Practice Address - Country:US
Practice Address - Phone:301-288-8344
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-05-12
Last Update Date:2025-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDCER-138347-K7T1C3103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool