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Individual
MRS. THERESA MARIE BEACH
Active
Individual
MRS. THERESA MARIE BEACH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LCSW R
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
R044998
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
338407
MVP VALUE OPTIONS
NY
01
—
P010044998
BLUE CROSS BLUE SHIELD
NY
Enumeration date
05/10/2006
Last updated
07/13/2010
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