Healthcare Provider Details

I. General information

NPI: 1598091985
Provider Name (Legal Business Name): BRADLEY SCOTT BEAM PH.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/20/2009
Last Update Date: 11/06/2024
Certification Date: 11/06/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8229 CLOVERLEAF DRIVE; SUITE 425 HALCYON WELLNESS CENTER
MILLERSVILLE MD
21108-2645
US

IV. Provider business mailing address

1409 FALCON NEST COURT
ARNOLD MD
21012
US

V. Phone/Fax

Practice location:
  • Phone: 443-875-5509
  • Fax:
Mailing address:
  • Phone: 443-875-5509
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number04627
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code103TS0200X
TaxonomySchool Psychologist
License NumberCER-152895-W5D7H2
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: