Provider Demographics
NPI:1316034762
Name:BELGRAVE, JEFFREY D (PHD)
Entity Type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:D
Last Name:BELGRAVE
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:49 WILLOW AVE
Mailing Address - Street 2:
Mailing Address - City:ROCKAWAY
Mailing Address - State:NJ
Mailing Address - Zip Code:07866-2825
Mailing Address - Country:US
Mailing Address - Phone:973-586-9872
Mailing Address - Fax:
Practice Address - Street 1:15 STATE ROUTE 15
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:NJ
Practice Address - Zip Code:07848-2007
Practice Address - Country:US
Practice Address - Phone:973-579-6700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ35SI00203300103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical