Healthcare Provider Details

I. General information

NPI: 1174180210
Provider Name (Legal Business Name): BEVERLY SCHOOL FOR THE DEAF
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/23/2019
Last Update Date: 05/23/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6 ECHO AVE
BEVERLY MA
01915-2497
US

IV. Provider business mailing address

6 ECHO AVE
BEVERLY MA
01915-2497
US

V. Phone/Fax

Practice location:
  • Phone: 978-927-7070
  • Fax: 978-927-6536
Mailing address:
  • Phone: 978-927-7070
  • Fax: 978-927-6536

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2080P0006X
TaxonomyDevelopmental - Behavioral Pediatrics Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number State
# 5
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number State

VIII. Authorized Official

Name: DR. MARK CARLSON
Title or Position: CEO
Credential:
Phone: 978-927-7070