Provider Demographics
NPI:1558411686
Name:BELZER & GRUNHAUS-BELZER PSYCHOLOGICAL CORPORATION
Entity Type:Organization
Organization Name:BELZER & GRUNHAUS-BELZER PSYCHOLOGICAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:HAIM BELZER
Authorized Official - Middle Name:
Authorized Official - Last Name:BELZER
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:858-278-0203
Mailing Address - Street 1:4550 KEARNY VILLA RD
Mailing Address - Street 2:SUITE 109
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92123-1578
Mailing Address - Country:US
Mailing Address - Phone:858-278-0203
Mailing Address - Fax:858-278-4972
Practice Address - Street 1:4550 KEARNY VILLA RD
Practice Address - Street 2:SUITE 109
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92123-1578
Practice Address - Country:US
Practice Address - Phone:858-278-0203
Practice Address - Fax:858-278-4972
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-11
Last Update Date:2015-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAW16053Medicare ID - Type Unspecified