Healthcare Provider Details

I. General information

NPI: 1649465741
Provider Name (Legal Business Name): MAYA SOPHIA BELITSKI PSY.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: MAYA ODZELASHVILI

II. Dates (important events)

Enumeration Date: 09/11/2007
Last Update Date: 03/21/2025
Certification Date: 03/20/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

PO BOX 9169 W. STATE STREET #2427
GARDEN CITY ID
83714
US

IV. Provider business mailing address

16 LINCOLN ST STE C
BRUNSWICK ME
04011-1900
US

V. Phone/Fax

Practice location:
  • Phone: 310-869-1549
  • Fax:
Mailing address:
  • Phone: 603-883-0005
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPSY30848
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPS2611
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: