Healthcare Provider Details

I. General information

NPI: 1619882974
Provider Name (Legal Business Name): ELIZABETH BEAGLE, LMHC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/18/2026
Last Update Date: 08/18/2026
Certification Date: 08/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

730 STATE ROUTE 143
RAVENA NY
12143-2511
US

IV. Provider business mailing address

730 STATE ROUTE 143
RAVENA NY
12143-2511
US

V. Phone/Fax

Practice location:
  • Phone: 518-708-9788
  • Fax: 518-545-4196
Mailing address:
  • Phone: 518-708-9788
  • Fax: 518-545-4196

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: ELIZABETH BEAGLE
Title or Position: OWNER, OPERATOR
Credential: LMHC
Phone: 518-708-9788