Healthcare Provider Details

I. General information

NPI: 1164700720
Provider Name (Legal Business Name): DIANE BEACH L.M.H.C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/01/2011
Last Update Date: 01/05/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4 HIGH ST. SUITE 101
NORTH ANDOVER MA
01845-2572
US

IV. Provider business mailing address

4 HIGH ST. SUITE 101
NORTH ANDOVER MA
01845-2572
US

V. Phone/Fax

Practice location:
  • Phone: 508-265-3023
  • Fax:
Mailing address:
  • Phone: 508-265-3023
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number6559
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: