Healthcare Provider Details

I. General information

NPI: 1013871805
Provider Name (Legal Business Name): ALEX BEATON LMHC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/15/2025
Last Update Date: 12/15/2025
Certification Date: 12/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

92 HIGH ST
MEDFORD MA
02155-1285
US

IV. Provider business mailing address

27 BARBARA RD
NEWTON MA
02465-1123
US

V. Phone/Fax

Practice location:
  • Phone: 617-702-9131
  • Fax:
Mailing address:
  • Phone: 617-650-8958
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberLMHC10005640
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: