MEDICARE: DR. ALYSE C BEEKMAN 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	003334	CT
2	103TC0700X	Clinical Psychologist	020139	NY

General Provider Information

NPI Number	:	1891183638
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ALYSE C BEEKMAN PSY.D.

Provider Business Mailing Address
First Line	:	1767 SUMMER ST
Second Line	:	2ND FLOOR
City	:	STAMFORD
State	:	CT
Zip	:	06905-5123
Country	:	US
Telephone Number	:	734-883-5300
Fax Number	:

Provider Business Practice Location Address
First Line	:	1767 SUMMER ST
Second Line	:	2ND FLOOR
City	:	STAMFORD
State	:	CT
Zip	:	06905-5123
Country	:	US
Telephone Number	:	734-883-5300
Fax Number	:

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

Provider Enumeration Date	:	01/01/2015
Last Update Date	:	01/01/2015

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