Healthcare Provider Details

I. General information

NPI: 1376544007
Provider Name (Legal Business Name): VICTORIA AZRIN BESALEL PHD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: VICTORIA BESALEL AZRIN PHD

II. Dates (important events)

Enumeration Date: 08/03/2005
Last Update Date: 05/25/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5151 BAYVIEW DR
FT LAUDERDALE FL
33308-3433
US

IV. Provider business mailing address

5151 BAYVIEW DR
FT LAUDERDALE FL
33308-3433
US

V. Phone/Fax

Practice location:
  • Phone: 954-491-6984
  • Fax: 954-491-7068
Mailing address:
  • Phone: 954-491-6984
  • Fax: 954-491-7068

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPY 3271
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: