MEDICARE: ELIZABETH BRADY BEACH NCC, LAC, BCBA

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	101Y00000X	Counselor	37AC00064400	NJ
2	101YS0200X	School Counselor	705548	NJ

General Provider Information

NPI Number	:	1861869943
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ELIZABETH BRADY BEACH NCC, LAC, BCBA

Provider Business Mailing Address
First Line	:	1100 MAXWELL LN
Second Line	:	UNIT 610
City	:	HOBOKEN
State	:	NJ
Zip	:	07030-6882
Country	:	US
Telephone Number	:	317-670-7490
Fax Number	:

Provider Business Practice Location Address
First Line	:	1100 MAXWELL LN
Second Line	:	UNIT 610
City	:	HOBOKEN
State	:	NJ
Zip	:	07030-6882
Country	:	US
Telephone Number	:	317-670-7490
Fax Number	:

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

Provider Enumeration Date	:	08/25/2015
Last Update Date	:	03/25/2026

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