Healthcare Provider Details

I. General information

NPI: 1689064040
Provider Name (Legal Business Name): ONIZAN EL ALEEM BEY MHS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/23/2015
Last Update Date: 01/23/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2275 BRIDGE ST
PHILADELPHIA PA
19137-2307
US

IV. Provider business mailing address

7356 WOODCREST AVE
PHILADELPHIA PA
19151-2213
US

V. Phone/Fax

Practice location:
  • Phone: 215-772-0101
  • Fax: 215-772-0303
Mailing address:
  • Phone: 267-847-2016
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: