Provider Demographics
NPI:1427299965
Name:BELKOURA, CAROLINE RACINE (PHD)
Entity type:Individual
Prefix:DR
First Name:CAROLINE
Middle Name:RACINE
Last Name:BELKOURA
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:400 PARNASSUS AVE # A808
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94143-0350
Mailing Address - Country:US
Mailing Address - Phone:415-298-4859
Mailing Address - Fax:415-353-9060
Practice Address - Street 1:400 PARNASSUS AVE # A808
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94143-0350
Practice Address - Country:US
Practice Address - Phone:415-298-4859
Practice Address - Fax:415-353-9060
Is Sole Proprietor?:No
Enumeration Date:2009-03-12
Last Update Date:2013-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY22575103G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist