Healthcare Provider Details

I. General information

NPI: 1871980409
Provider Name (Legal Business Name): VERA CATHERINE BEATON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/21/2015
Last Update Date: 04/21/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8855 CENTER POINTE DR
BALDWINSVILLE NY
13027-1421
US

IV. Provider business mailing address

4193 CANAL RD
MADISON NY
13402-1507
US

V. Phone/Fax

Practice location:
  • Phone: 315-766-6729
  • Fax:
Mailing address:
  • Phone: 315-893-9996
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number490244-1
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code163WA0400X
TaxonomyAddiction (Substance Use Disorder) Registered Nurse
License Number490244-1
License Number StateNY
# 3
Primary TaxonomyN
Taxonomy Code163WA2000X
TaxonomyAdministrator Registered Nurse
License Number490244-1
License Number StateNY
# 4
Primary TaxonomyN
Taxonomy Code163WC0400X
TaxonomyCase Management Registered Nurse
License Number490244-1
License Number StateNY
# 5
Primary TaxonomyN
Taxonomy Code163WM0705X
TaxonomyMedical-Surgical Registered Nurse
License Number490244-1
License Number StateNY
# 6
Primary TaxonomyN
Taxonomy Code163WP0807X
TaxonomyChild & Adolescent Psychiatric/Mental Health Registered Nurse
License Number490244-1
License Number StateNY
# 7
Primary TaxonomyN
Taxonomy Code163WP0809X
TaxonomyAdult Psychiatric/Mental Health Registered Nurse
License Number490244-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: