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General NPI Number Information
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NPI Number | 1609468354
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Entity Type | Individual
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Provider Name | DESIRAI BEARD
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Gender | Female
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Dates
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Enumeration Date | 02/04/2021
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Last Update Date | 02/04/2021
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Provider Practice Location Address
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Address Line | 5928 FIRESTONE RD
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City | JACKSONVILLE
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State | FL
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Zip | 32244-1628
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Country | US
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Telephone | 585-285-7056
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Fax |
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Provider Business Mailing Address
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Address Line | 5575 S SEMORAN BLVD STE 36
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City | ORLANDO
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State | FL
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Zip | 32822-1782
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Country | US
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Telephone | 585-285-7056
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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 | 103TH0100X
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Taxonomy Name | Health Service Psychologist
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License Number |
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License Number State |
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