Provider Demographics
NPI:1801023064
Name:BELKONEN, STACY (PHD)
Entity type:Individual
Prefix:
First Name:STACY
Middle Name:
Last Name:BELKONEN
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 1:1970 ROANOKE BLVD
Mailing Address - Street 2:116B-1
Mailing Address - City:ROANOKE
Mailing Address - State:VA
Mailing Address - Zip Code:24019
Mailing Address - Country:US
Mailing Address - Phone:540-982-2463
Mailing Address - Fax:540-983-1085
Practice Address - Street 1:1970 ROANOKE BLVD
Practice Address - Street 2:116B-1
Practice Address - City:ROANOKE
Practice Address - State:VA
Practice Address - Zip Code:24019
Practice Address - Country:US
Practice Address - Phone:540-982-2463
Practice Address - Fax:540-983-1085
Is Sole Proprietor?:No
Enumeration Date:2009-06-15
Last Update Date:2011-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY017929-1103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist