Healthcare Provider Details

I. General information

NPI: 1124207980
Provider Name (Legal Business Name): JANE BEATTY LMHC, AAT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/29/2007
Last Update Date: 10/29/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

133 FALMOUTH RD BUILDING 1, SUITE F
MASHPEE MA
02649-2611
US

IV. Provider business mailing address

77 CARL LANDI CIR
EAST FALMOUTH MA
02536-7752
US

V. Phone/Fax

Practice location:
  • Phone: 508-274-8957
  • Fax: 508-477-2499
Mailing address:
  • Phone: 508-274-8957
  • Fax: 508-437-0239

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number5900
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: