Provider Demographics
NPI:1376544007
Name:BESALEL, VICTORIA AZRIN (PHD)
Entity Type:Individual
Prefix:
First Name:VICTORIA
Middle Name:AZRIN
Last Name:BESALEL
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:VICTORIA
Other - Middle Name:BESALEL
Other - Last Name:AZRIN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PHD
Mailing Address - Street 1:5151 BAYVIEW DR
Mailing Address - Street 2:
Mailing Address - City:FT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33308-3433
Mailing Address - Country:US
Mailing Address - Phone:954-491-6984
Mailing Address - Fax:954-491-7068
Practice Address - Street 1:5151 BAYVIEW DR
Practice Address - Street 2:
Practice Address - City:FT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33308-3433
Practice Address - Country:US
Practice Address - Phone:954-491-6984
Practice Address - Fax:954-491-7068
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-03
Last Update Date:2010-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY 3271103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL75651Medicare ID - Type Unspecified