Provider Demographics
NPI:1750306403
Name:BELSHAM, RICHARD LEE (PHD)
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:LEE
Last Name:BELSHAM
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 1:5190 26TH ST W
Mailing Address - Street 2:SUITE B
Mailing Address - City:BRADENTON
Mailing Address - State:FL
Mailing Address - Zip Code:34207-2255
Mailing Address - Country:US
Mailing Address - Phone:941-756-8816
Mailing Address - Fax:941-756-4581
Practice Address - Street 1:5190 26TH ST W
Practice Address - Street 2:SUITE B
Practice Address - City:BRADENTON
Practice Address - State:FL
Practice Address - Zip Code:34207-2255
Practice Address - Country:US
Practice Address - Phone:941-756-8816
Practice Address - Fax:941-756-4581
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY4962103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL59481Medicare ID - Type Unspecified