Provider Demographics
NPI:1265962690
Name:BEACON BEHAVIORAL HEALTH ASSOCIATES PLLC
Entity type:Organization
Organization Name:BEACON BEHAVIORAL HEALTH ASSOCIATES PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KATHLEEN
Authorized Official - Middle Name:
Authorized Official - Last Name:BYRNE
Authorized Official - Suffix:
Authorized Official - Credentials:APRN
Authorized Official - Phone:774-454-1634
Mailing Address - Street 1:243 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:BUZZARDS BAY
Mailing Address - State:MA
Mailing Address - Zip Code:02532-3234
Mailing Address - Country:US
Mailing Address - Phone:774-454-1634
Mailing Address - Fax:866-437-5208
Practice Address - Street 1:243 MAIN ST
Practice Address - Street 2:
Practice Address - City:BUZZARDS BAY
Practice Address - State:MA
Practice Address - Zip Code:02532-3234
Practice Address - Country:US
Practice Address - Phone:774-454-1634
Practice Address - Fax:866-437-5208
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-06-18
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental HealthGroup - Multi-Specialty