MEDICARE: MARIAM BESHARA LPC., 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	101YP2500X	Professional Counselor

General Provider Information

NPI Number	:	1053903732
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MARIAM BESHARA LPC., PSYD

Provider Business Mailing Address
First Line	:	2645 STARWOOD CIR
Second Line	:
City	:	WEST PALM BCH
State	:	FL
Zip	:	33406-5146
Country	:	US
Telephone Number	:	561-386-7939
Fax Number	:

Provider Business Practice Location Address
First Line	:	2645 STARWOOD CIR
Second Line	:
City	:	WEST PALM BEACH
State	:	FL
Zip	:	33406-5146
Country	:	US
Telephone Number	:	561-406-4318
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	MARIAM BESHARA
Credential	:	LPC., PSYD
Telephone Number	:	561-386-7939

Provider Enumeration Date	:	02/04/2021
Last Update Date	:	11/03/2022

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