Healthcare Provider Details

I. General information

NPI: 1912292442
Provider Name (Legal Business Name): ELAINE RE'NADA BEDDEN MA, LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/13/2011
Last Update Date: 07/02/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8220 CASTOR AVE
PHILADELPHIA PA
19152-2729
US

IV. Provider business mailing address

8220 CASTOR AVE
PHILADELPHIA PA
19152-2729
US

V. Phone/Fax

Practice location:
  • Phone: 215-803-0246
  • Fax: 267-305-4887
Mailing address:
  • Phone: 215-803-0246
  • Fax: 267-305-4887

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberPC006702
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: