Provider Demographics
NPI:1275127813
Name:BELOKON, IGOR (PHD, PSYD)
Entity Type:Individual
Prefix:DR
First Name:IGOR
Middle Name:
Last Name:BELOKON
Suffix:
Gender:M
Credentials:PHD, PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3440 NE 192ND ST APT 4K
Mailing Address - Street 2:
Mailing Address - City:AVENTURA
Mailing Address - State:FL
Mailing Address - Zip Code:33180-2424
Mailing Address - Country:US
Mailing Address - Phone:305-335-8531
Mailing Address - Fax:
Practice Address - Street 1:3440 NE 192ND ST APT 4K
Practice Address - Street 2:
Practice Address - City:AVENTURA
Practice Address - State:FL
Practice Address - Zip Code:33180-2424
Practice Address - Country:US
Practice Address - Phone:305-335-8531
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-02-24
Last Update Date:2021-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY7256103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical