Provider Demographics
NPI:1649465741
Name:BELITSKI, MAYA SOPHIA (PSYD)
Entity type:Individual
Prefix:DR
First Name:MAYA
Middle Name:SOPHIA
Last Name:BELITSKI
Suffix:
Gender:
Credentials:PSYD
Other - Prefix:
Other - First Name:MAYA
Other - Middle Name:
Other - Last Name:ODZELASHVILI
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:16 LINCOLN ST STE C
Mailing Address - Street 2:
Mailing Address - City:BRUNSWICK
Mailing Address - State:ME
Mailing Address - Zip Code:04011-1900
Mailing Address - Country:US
Mailing Address - Phone:603-883-0005
Mailing Address - Fax:
Practice Address - Street 1:PO BOX 9169 W. STATE STREET
Practice Address - Street 2:#2427
Practice Address - City:GARDEN CITY
Practice Address - State:ID
Practice Address - Zip Code:83714
Practice Address - Country:US
Practice Address - Phone:310-869-1549
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-11
Last Update Date:2025-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY30848103TC0700X
MEPS2611103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical