Healthcare Provider Details

I. General information

NPI: 1285406066
Provider Name (Legal Business Name): BEAMING MIND PSYCHOLOGY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/25/2023
Last Update Date: 01/02/2024
Certification Date: 01/02/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1101 TAMIAMI TRL S STE 215A-1
VENICE FL
34285-4133
US

IV. Provider business mailing address

14370 59TH CIR E
BRADENTON FL
34211-0740
US

V. Phone/Fax

Practice location:
  • Phone: 941-842-3837
  • Fax:
Mailing address:
  • Phone: 941-842-3837
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. VERONICA PATRICIA MEDINA
Title or Position: OWNER
Credential: PSYD
Phone: 484-408-4646