Provider Demographics
NPI:1497994271
Name:PROSKUROV, BELLA (PHD)
Entity Type:Individual
Prefix:DR
First Name:BELLA
Middle Name:
Last Name:PROSKUROV
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20 COLUMBIA PL
Mailing Address - Street 2:#B44
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11201-4564
Mailing Address - Country:US
Mailing Address - Phone:646-251-3462
Mailing Address - Fax:
Practice Address - Street 1:20 COLUMBIA PL
Practice Address - Street 2:#B44
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11201-4564
Practice Address - Country:US
Practice Address - Phone:646-251-3462
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-02-18
Last Update Date:2009-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY017568103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical