Provider Demographics
NPI:1124598800
Name:BEVER, VANESSA (MFT)
Entity Type:Individual
Prefix:
First Name:VANESSA
Middle Name:
Last Name:BEVER
Suffix:
Gender:F
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:108 THORNBERRY LN
Mailing Address - Street 2:
Mailing Address - City:RENSSELAER
Mailing Address - State:NY
Mailing Address - Zip Code:12144-8448
Mailing Address - Country:US
Mailing Address - Phone:818-620-1392
Mailing Address - Fax:
Practice Address - Street 1:406 FULTON ST STE 509
Practice Address - Street 2:
Practice Address - City:TROY
Practice Address - State:NY
Practice Address - Zip Code:12180-3359
Practice Address - Country:US
Practice Address - Phone:518-880-2395
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-11-26
Last Update Date:2018-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY001524106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist