Provider Demographics
NPI:1043691256
Name:BELKNAP, NANCY RUTH (CAS)
Entity type:Individual
Prefix:MRS
First Name:NANCY
Middle Name:RUTH
Last Name:BELKNAP
Suffix:
Gender:F
Credentials:CAS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5444 EL CARRO LANE
Mailing Address - Street 2:
Mailing Address - City:CARPINTERIA
Mailing Address - State:CA
Mailing Address - Zip Code:93013
Mailing Address - Country:US
Mailing Address - Phone:805-729-2118
Mailing Address - Fax:
Practice Address - Street 1:5444 EL CARRO LN
Practice Address - Street 2:
Practice Address - City:CARPINTERIA
Practice Address - State:CA
Practice Address - Zip Code:93013-1543
Practice Address - Country:US
Practice Address - Phone:805-729-2118
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-06-12
Last Update Date:2015-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA01-052996101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)