MEDICARE: BREANNA BEARDSLEY

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	106S00000X	Behavior Technician

General Provider Information

NPI Number	:	1851998991
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BREANNA BEARDSLEY

Provider Business Mailing Address
First Line	:	6 NELSON ST
Second Line	:
City	:	WEBSTER
State	:	MA
Zip	:	01570-1814
Country	:	US
Telephone Number	:	774-280-9200
Fax Number	:

Provider Business Practice Location Address
First Line	:	6225 SMITH AVE
Second Line	:
City	:	BALTIMORE
State	:	MD
Zip	:	21209-3626
Country	:	US
Telephone Number	:	401-369-0000
Fax Number	:

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

Provider Enumeration Date	:	10/01/2020
Last Update Date	:	10/01/2020

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Directions to “ BREANNA BEARDSLEY ” Practice Location

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