Provider Demographics
NPI:1629819776
Name:BELIZAIRE, GREGOIRE ANDRE III (AA)
Entity type:Individual
Prefix:MR
First Name:GREGOIRE
Middle Name:ANDRE
Last Name:BELIZAIRE
Suffix:III
Gender:M
Credentials:AA
Other - Prefix:MR
Other - First Name:GREG
Other - Middle Name:ANDRE
Other - Last Name:BELIZAIRE
Other - Suffix:III
Other - Last Name Type:Professional Name
Other - Credentials:AA
Mailing Address - Street 1:1500 S DOUGLAS RD
Mailing Address - Street 2:
Mailing Address - City:CORAL GABLES
Mailing Address - State:FL
Mailing Address - Zip Code:33134-4108
Mailing Address - Country:US
Mailing Address - Phone:844-244-1818
Mailing Address - Fax:888-512-0733
Practice Address - Street 1:1500 S DOUGLAS RD STE 230
Practice Address - Street 2:
Practice Address - City:CORAL GABLES
Practice Address - State:FL
Practice Address - Zip Code:33134-4108
Practice Address - Country:US
Practice Address - Phone:844-244-1818
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-06-03
Last Update Date:2024-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNBACB978727106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNBACB978727OtherBACB CERTIFICATION NUMBER