Provider Demographics
NPI:1942284963
Name:BELVEDERE, MARIANA (PHD)
Entity Type:Individual
Prefix:MS
First Name:MARIANA
Middle Name:
Last Name:BELVEDERE
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 1:503 CENTRE VIEW BLVD.
Mailing Address - Street 2:
Mailing Address - City:CRESTVIEW HILLS
Mailing Address - State:KY
Mailing Address - Zip Code:41017-3444
Mailing Address - Country:US
Mailing Address - Phone:859-426-7800
Mailing Address - Fax:859-426-7804
Practice Address - Street 1:503 CENTRE VIEW BLVD.
Practice Address - Street 2:MCB BEHAVIORAL HEALTH
Practice Address - City:CRESTVIEW HILLS
Practice Address - State:KY
Practice Address - Zip Code:41017-3444
Practice Address - Country:US
Practice Address - Phone:859-426-7800
Practice Address - Fax:859-426-7804
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-02
Last Update Date:2010-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY1304103TC0700X
OH5899103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
770614456OtherTAX IDENTIFICATION NUMBER
KY89000863Medicaid
KY7978Medicare ID - Type UnspecifiedGROUP
KY89000863Medicaid
KYP72398Medicare UPIN