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General NPI Number Information
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NPI Number | 1912797804
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Entity Type | Individual
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Provider Name | MYA GRACE BERON ED.S., NCSP
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Gender | Female
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Dates
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Enumeration Date | 05/12/2025
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Last Update Date | 05/12/2025
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Provider Practice Location Address
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Address Line | 218 GREENWOOD LOOP RD
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City | BRICK
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State | NJ
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Zip | 08724-1261
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Country | US
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Telephone | 304-266-4426
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Fax |
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Provider Business Mailing Address
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Address Line | 218 GREENWOOD LOOP RD
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City | BRICK
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State | NJ
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Zip | 08724-1261
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Country | US
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Telephone | 304-266-4426
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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 | 103TS0200X
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Taxonomy Name | School Psychologist
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License Number | 01843756
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License Number State | NJ
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Taxonomy #2
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Taxonomy Code | 103TS0200X
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Taxonomy Name | School Psychologist
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License Number | 22168625
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License Number State | OH
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