MEDICARE: SOUTH BEACH PSYCHOLOGY INC

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	PY6493	FL

General Provider Information

NPI Number	:	1528074002
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SOUTH BEACH PSYCHOLOGY INC

Provider Business Mailing Address
First Line	:	333 W 41ST ST
Second Line	:	SUITE NUMBER 710
City	:	MIAMI BEACH
State	:	FL
Zip	:	33140-3641
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3328 GARDEN AVE
Second Line	:
City	:	MIAMI BEACH
State	:	FL
Zip	:	33140-3822
Country	:	US
Telephone Number	:	786-303-4422
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. ZEIVEN BEN BEITCHMAN
Credential	:
Telephone Number	:	786-303-4422

Provider Enumeration Date	:	08/01/2006
Last Update Date	:	06/13/2011

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