Provider Demographics
NPI:1184824641
Name:MITTMAN, BEATRICE LANDMAN (PHD)
Entity Type:Individual
Prefix:DR
First Name:BEATRICE
Middle Name:LANDMAN
Last Name:MITTMAN
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1117 ELBERON AVE
Mailing Address - Street 2:
Mailing Address - City:LONG BRANCH
Mailing Address - State:NJ
Mailing Address - Zip Code:07740-4555
Mailing Address - Country:US
Mailing Address - Phone:732-870-0451
Mailing Address - Fax:732-222-1366
Practice Address - Street 1:1117 ELBERON AVE
Practice Address - Street 2:
Practice Address - City:LONG BRANCH
Practice Address - State:NJ
Practice Address - Zip Code:07740-4555
Practice Address - Country:US
Practice Address - Phone:732-870-0451
Practice Address - Fax:732-222-1366
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-23
Last Update Date:2007-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ35SI00307500103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ444419Medicare PIN