Provider Demographics
NPI:1275509663
Name:THE BEVERLY CENTER, P.C.
Entity Type:Organization
Organization Name:THE BEVERLY CENTER, P.C.
Other - Org Name:BEVERLY CENTER, P.C.
Other - Org Type:Other Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:GEORGE
Authorized Official - Middle Name:IVAN
Authorized Official - Last Name:BEILIN
Authorized Official - Suffix:
Authorized Official - Credentials:EDD
Authorized Official - Phone:978-922-6613
Mailing Address - Street 1:100 CUMMINGS CTR
Mailing Address - Street 2:
Mailing Address - City:BEVERLY
Mailing Address - State:MA
Mailing Address - Zip Code:01915-6113
Mailing Address - Country:US
Mailing Address - Phone:978-922-6613
Mailing Address - Fax:978-921-1094
Practice Address - Street 1:100 CUMMINGS CENTER
Practice Address - Street 2:
Practice Address - City:BEVERLY
Practice Address - State:MA
Practice Address - Zip Code:01915-6113
Practice Address - Country:US
Practice Address - Phone:978-922-6613
Practice Address - Fax:978-921-1094
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-02-24
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA103TC2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & AdolescentGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAW40003Medicare ID - Type Unspecified