Healthcare Provider Details

I. General information

NPI: 1518588813
Provider Name (Legal Business Name): ROBERT BELGROD LPAT, LCAT, ATR-BC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/28/2020
Last Update Date: 11/17/2022
Certification Date: 11/17/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

76 LOS ALTOS DE CICUYE
PECOS NM
87552-2555
US

IV. Provider business mailing address

76 LOS ALTOS DE CICUYE
PECOS NM
87552-2555
US

V. Phone/Fax

Practice location:
  • Phone: 808-366-9739
  • Fax:
Mailing address:
  • Phone: 808-366-9739
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code221700000X
TaxonomyArt Therapist
License Number002152
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code221700000X
TaxonomyArt Therapist
License NumberCAT0208121
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: