Healthcare Provider Details

I. General information

NPI: 1184996753
Provider Name (Legal Business Name): GRACE EVA BEACH LMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/30/2012
Last Update Date: 01/30/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 DOANSBURG RD
BREWSTER NY
10509-5902
US

IV. Provider business mailing address

400 DOANSBURG ROAD
BREWSTER NY
10509
US

V. Phone/Fax

Practice location:
  • Phone: 845-279-2995
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number084881-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: