MEDICARE: ELLEN BEYDA 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
1	103TC0700X	Clinical Psychologist	014761-1	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1851348254
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ELLEN BEYDA PSY.D.

Provider Business Mailing Address
First Line	:	311 15TH ST
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11215-5005
Country	:	US
Telephone Number	:	917-538-5104
Fax Number	:

Provider Business Practice Location Address
First Line	:	115 W 27TH ST
Second Line	:	4
City	:	NEW YORK
State	:	NY
Zip	:	10001-6217
Country	:	US
Telephone Number	:	917-538-5104
Fax Number	:

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

Provider Enumeration Date	:	05/30/2006
Last Update Date	:	02/27/2014

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