MEDICARE: BEVERLY A NORTON PSYD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103TC0700X	Clinical Psychologist	PSY22268	CA

General Provider Information

NPI Number	:	1023168150
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BEVERLY A NORTON PSYD

Provider Business Mailing Address
First Line	:	PO BOX 1376
Second Line	:
City	:	IONE
State	:	CA
Zip	:	95640-1376
Country	:	US
Telephone Number	:	707-575-4831
Fax Number	:

Provider Business Practice Location Address
First Line	:	293 RAILROAD FLAT RD
Second Line	:
City	:	MOKELUMNE HILL
State	:	CA
Zip	:	95245
Country	:	US
Telephone Number	:	707-480-4831
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/11/2007
Last Update Date	:	01/26/2021

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