Healthcare Provider Details

I. General information

NPI: 1902490634
Provider Name (Legal Business Name): ERIN BEATO MA LLP PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/23/2021
Last Update Date: 03/02/2021
Certification Date: 03/02/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15450 E JEFFERSON AVE STE 180
GROSSE POINTE PARK MI
48230-2031
US

IV. Provider business mailing address

15450 E JEFFERSON AVE STE 180
GROSSE POINTE PARK MI
48230-2031
US

V. Phone/Fax

Practice location:
  • Phone: 586-822-8832
  • Fax:
Mailing address:
  • Phone: 586-822-8832
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number
License Number State

VIII. Authorized Official

Name: ERIN BEATO
Title or Position: PSYCHOTHERAPIST
Credential:
Phone: 586-822-8832