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NPI Code Detail

MEDICARE: MR. BEAU CHARLES BRENDLEY PSY D

MEDICARE: MR. BEAU CHARLES BRENDLEY PSY D
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
1101YP2500XProfessional CounselorPC006129PA
2103T00000XPsychologistPS018603PA

General Provider Information

NPI Number : 1447537766
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. BEAU CHARLES BRENDLEY PSY D
Provider Business Mailing Address
First Line : 815 S 2ND ST
Second Line :
City : PHILADELPHIA
State : PA
Zip : 19147-3415
Country : US
Telephone Number : 267-231-9588
Fax Number :
Provider Business Practice Location Address
First Line : 255 S 17TH ST STE 1010
Second Line :
City : PHILADELPHIA
State : PA
Zip : 19103-6210
Country : US
Telephone Number : 672-319-5882
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/15/2011
Last Update Date : 09/25/2018

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