Provider Demographics
NPI:1093255184
Name:BEAN, ABIGAIL
Entity Type:Individual
Prefix:
First Name:ABIGAIL
Middle Name:
Last Name:BEAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:ABIGAIL
Other - Middle Name:
Other - Last Name:ROH
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:REMI BEAN
Mailing Address - Street 1:269 CHURCH ST.
Mailing Address - Street 2:SUITE 11
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94114
Mailing Address - Country:US
Mailing Address - Phone:413-889-4114
Mailing Address - Fax:
Practice Address - Street 1:269 CHURCH ST.
Practice Address - Street 2:SUITE 11
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94114
Practice Address - Country:US
Practice Address - Phone:413-889-4114
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-03-08
Last Update Date:2024-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA10097101YM0800X, 101YP2500X
CA4876101YP2500X
101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional