Healthcare Provider Details

I. General information

NPI: 1548546203
Provider Name (Legal Business Name): CORTNEY R BEASLEY PSYD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/26/2011
Last Update Date: 04/15/2020
Certification Date: 04/15/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

625 MARKET ST FL 15
SAN FRANCISCO CA
94105-3316
US

IV. Provider business mailing address

625 MARKET ST FL 15
SAN FRANCISCO CA
94105-3316
US

V. Phone/Fax

Practice location:
  • Phone: 415-360-3833
  • Fax:
Mailing address:
  • Phone: 415-360-3833
  • Fax: 617-414-1975

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number31751
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: