Provider Demographics
NPI:1326244328
Name:BELOSO, DANIELLE (PSYCHOLOGIST)
Entity Type:Individual
Prefix:DR
First Name:DANIELLE
Middle Name:
Last Name:BELOSO
Suffix:
Gender:F
Credentials:PSYCHOLOGIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2555 E 55TH PL
Mailing Address - Street 2:SUITE 202
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46220-3549
Mailing Address - Country:US
Mailing Address - Phone:317-931-9241
Mailing Address - Fax:
Practice Address - Street 1:2555 E 55TH PL
Practice Address - Street 2:SUITE 202
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46220-3549
Practice Address - Country:US
Practice Address - Phone:317-931-9241
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-06-26
Last Update Date:2014-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ4709103T00000X
NY018052103T00000X
MECP1284103T00000X
IN20042422A103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist