Provider Demographics
NPI:1114094844
Name:BEAN, JANE R (LIC AC)
Entity Type:Individual
Prefix:
First Name:JANE
Middle Name:R
Last Name:BEAN
Suffix:
Gender:F
Credentials:LIC AC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:49 WILDWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:GREENFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01301-1213
Mailing Address - Country:US
Mailing Address - Phone:413-773-9605
Mailing Address - Fax:
Practice Address - Street 1:49 WILDWOOD AVE
Practice Address - Street 2:
Practice Address - City:GREENFIELD
Practice Address - State:MA
Practice Address - Zip Code:01301-1213
Practice Address - Country:US
Practice Address - Phone:413-773-9605
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA311171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist