Healthcare Provider Details

I. General information

NPI: 1952234304
Provider Name (Legal Business Name): BEACON HEIGHTS PSYCHOLOGY PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/05/2026
Last Update Date: 06/05/2026
Certification Date: 06/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2 BAY CLUB DR APT 19J
BAYSIDE NY
11360-2932
US

IV. Provider business mailing address

2 BAY CLUB DR APT 19J
BAYSIDE NY
11360-2932
US

V. Phone/Fax

Practice location:
  • Phone: 617-838-1286
  • Fax:
Mailing address:
  • Phone: 617-838-1286
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number
License Number State

VIII. Authorized Official

Name: JOANNA WING YAN POON
Title or Position: PSYCHOLOGIST
Credential: PSY.D.
Phone: 617-838-1286