Provider Demographics
NPI:1154910545
Name:BELIZAIRE, BRIGITTE K (MS)
Entity type:Individual
Prefix:
First Name:BRIGITTE
Middle Name:K
Last Name:BELIZAIRE
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1850 LEE RD STE 332
Mailing Address - Street 2:
Mailing Address - City:WINTER PARK
Mailing Address - State:FL
Mailing Address - Zip Code:32789-2164
Mailing Address - Country:US
Mailing Address - Phone:407-637-2633
Mailing Address - Fax:
Practice Address - Street 1:1850 LEE RD STE 332
Practice Address - Street 2:
Practice Address - City:WINTER PARK
Practice Address - State:FL
Practice Address - Zip Code:32789-2164
Practice Address - Country:US
Practice Address - Phone:407-637-2633
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-01-11
Last Update Date:2021-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL475172421Medicaid