MEDICARE: VICTORIA AZRIN BESALEL PHD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103TC0700X	Clinical Psychologist	PY 3271	FL

General Provider Information

NPI Number	:	1376544007
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	VICTORIA AZRIN BESALEL PHD

Provider Business Mailing Address
First Line	:	5151 BAYVIEW DR
Second Line	:
City	:	FT LAUDERDALE
State	:	FL
Zip	:	33308-3433
Country	:	US
Telephone Number	:	954-491-6984
Fax Number	:	954-491-7068

Provider Business Practice Location Address
First Line	:	5151 BAYVIEW DR
Second Line	:
City	:	FT LAUDERDALE
State	:	FL
Zip	:	33308-3433
Country	:	US
Telephone Number	:	954-491-6984
Fax Number	:	954-491-7068

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/03/2005
Last Update Date	:	05/25/2010

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