Provider Demographics
NPI:1275772113
Name:BEASLEY, LEONA (MA, MFA)
Entity Type:Individual
Prefix:MS
First Name:LEONA
Middle Name:
Last Name:BEASLEY
Suffix:
Gender:F
Credentials:MA, MFA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3356 ADELINE ST
Mailing Address - Street 2:
Mailing Address - City:BERKELEY
Mailing Address - State:CA
Mailing Address - Zip Code:94703-2737
Mailing Address - Country:US
Mailing Address - Phone:510-985-2694
Mailing Address - Fax:
Practice Address - Street 1:3356 ADELINE ST
Practice Address - Street 2:
Practice Address - City:BERKELEY
Practice Address - State:CA
Practice Address - Zip Code:94703-2737
Practice Address - Country:US
Practice Address - Phone:510-985-2694
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-02-17
Last Update Date:2009-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist