Provider Demographics
NPI:1104871789
Name:BELYEA, SUSAN C (PHD)
Entity type:Individual
Prefix:DR
First Name:SUSAN
Middle Name:C
Last Name:BELYEA
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:DR
Other - First Name:SUSAN
Other - Middle Name:B
Other - Last Name:SLEDGE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2823 S ZENOBIA ST
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80236-2028
Mailing Address - Country:US
Mailing Address - Phone:303-330-7460
Mailing Address - Fax:
Practice Address - Street 1:2823 S ZENOBIA ST
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80236-2028
Practice Address - Country:US
Practice Address - Phone:303-330-7460
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-23
Last Update Date:2010-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO2833103TC0700X, 103TB0200X
VA0810002753103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103TB0200XBehavioral Health & Social Service ProvidersPsychologistCognitive & Behavioral
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA680001502Medicaid
CO5681339Medicaid
COC805641Medicare PIN
VA007704739Medicare ID - Type Unspecified