Healthcare Provider Details

I. General information

NPI: 1124871447
Provider Name (Legal Business Name): L DOLORES BELAFONTE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/08/2024
Last Update Date: 04/08/2024
Certification Date: 04/08/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1915 NE STUCKI AVE STE 400
HILLSBORO OR
97006-6938
US

IV. Provider business mailing address

3159 CARPENTERS PARK RD
DAVIDSVILLE PA
15928-9223
US

V. Phone/Fax

Practice location:
  • Phone: 814-408-0014
  • Fax:
Mailing address:
  • Phone: 814-408-0014
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number150.108895
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: