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General NPI Number Information
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NPI Number | 1063968238
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Entity Type | Individual
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Provider Name | JUSTIN BEYER
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Gender | Male
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Dates
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Enumeration Date | 08/28/2016
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Last Update Date | 08/21/2023
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Provider Practice Location Address
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Address Line | 100 GUERRANT ST # 2242
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City | UMATILLA
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State | FL
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Zip | 32784-8609
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Country | US
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Telephone | 609-685-3973
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Fax |
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Provider Business Mailing Address
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Address Line | 519 ELMWOOD RD N
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City | MARLTON
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State | NJ
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Zip | 08053-5503
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Country | US
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Telephone | 609-685-3973
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103K00000X
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Taxonomy Name | Behavior Analyst
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License Number | 1-12-12514
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License Number State | NJ
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