Healthcare Provider Details

I. General information

NPI: 1912063710
Provider Name (Legal Business Name): DEBRA SCHILD BEAUMONT LMHC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/28/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

59 LEICESTER ST THE CENTER - SUITE 110
PERRY NY
14530-1155
US

IV. Provider business mailing address

3675 SAINT HELENA ST
PERRY NY
14530-9527
US

V. Phone/Fax

Practice location:
  • Phone: 585-237-2764
  • Fax:
Mailing address:
  • Phone: 585-237-3983
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number001866-1
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: