Provider Demographics
NPI:1518737808
Name:MANAKHIMOVA, BELLA
Entity Type:Individual
Prefix:
First Name:BELLA
Middle Name:
Last Name:MANAKHIMOVA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1215 AVENUE N APT 3B
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11230-5955
Mailing Address - Country:US
Mailing Address - Phone:718-414-5819
Mailing Address - Fax:
Practice Address - Street 1:1215 AVENUE N APT 3B
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11230-5955
Practice Address - Country:US
Practice Address - Phone:718-414-5819
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-01-08
Last Update Date:2024-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY103TA0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TA0700XBehavioral Health & Social Service ProvidersPsychologistAdult Development & Aging