Provider Demographics
NPI:1558324434
Name:BELLHORN, KURT CHARLES (PHD)
Entity Type:Individual
Prefix:DR
First Name:KURT
Middle Name:CHARLES
Last Name:BELLHORN
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 1:14 SHERWOOD LN
Mailing Address - Street 2:
Mailing Address - City:MARLBOROUGH
Mailing Address - State:CT
Mailing Address - Zip Code:06447-1456
Mailing Address - Country:US
Mailing Address - Phone:860-468-9135
Mailing Address - Fax:860-652-8300
Practice Address - Street 1:148 EASTERN BLVD
Practice Address - Street 2:SUITE 306
Practice Address - City:GLASTONBURY
Practice Address - State:CT
Practice Address - Zip Code:06033-4321
Practice Address - Country:US
Practice Address - Phone:860-468-9135
Practice Address - Fax:860-652-8300
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-10
Last Update Date:2011-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT001690103G00000X, 103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT4126555Medicaid
CT4126555Medicaid