Provider Demographics
NPI:1134459878
Name:BELEN, THERESA BERNADETTE (MD)
Entity Type:Individual
Prefix:DR
First Name:THERESA
Middle Name:BERNADETTE
Last Name:BELEN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:627 S. EDWIN C. MOSES BLVD.
Mailing Address - Street 2:WSUSOM DEPARTMENT OF PSYCHIATRY
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45417-1461
Mailing Address - Country:US
Mailing Address - Phone:937-223-8840
Mailing Address - Fax:
Practice Address - Street 1:627 S. EDWIN C. MOSES BLVD.
Practice Address - Street 2:WSUSOM DEPARTMENT OF PSYCHIATRY
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45417-1461
Practice Address - Country:US
Practice Address - Phone:937-223-8840
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-12-31
Last Update Date:2009-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRESIDENT2084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry