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General NPI Number Information
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NPI Number | 1114740487
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Entity Type | Organization
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Legal Business Name | BEACON PSYCHIATRY PLLC
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Dates
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Enumeration Date | 11/05/2024
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Last Update Date | 11/05/2024
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Provider Practice Location Address
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Address Line | 5 BRISTOL DR STE 3F
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City | SOUTH EASTON
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State | MA
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Zip | 02375
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Country | US
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Telephone | 617-575-9830
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Fax |
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Provider Business Mailing Address
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Address Line | 6 LIBERTY SQ # 97524
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City | BOSTON
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State | MA
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Zip | 02109-5800
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Country | US
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Telephone | 617-575-9830
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Fax |
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Authorized Official
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Title or Position | PARTNER
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Name | TARA CONKLIN
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Credential | PMHNP
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Telephone | 203-858-1690
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 364SP0808X
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Taxonomy Name | Psychiatric/Mental Health Clinical Nurse Specialist
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License Number |
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License Number State |
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