Provider Demographics
NPI:1336459916
Name:BEAMAN, JOHN L (LCSW)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:L
Last Name:BEAMAN
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:324 GANNETT DR STE 300
Mailing Address - Street 2:
Mailing Address - City:SOUTH PORTLAND
Mailing Address - State:ME
Mailing Address - Zip Code:04106-3269
Mailing Address - Country:US
Mailing Address - Phone:207-771-5713
Mailing Address - Fax:207-771-5755
Practice Address - Street 1:324 GANNETT DR STE 300
Practice Address - Street 2:
Practice Address - City:SOUTH PORTLAND
Practice Address - State:ME
Practice Address - Zip Code:04106-3269
Practice Address - Country:US
Practice Address - Phone:207-771-5713
Practice Address - Fax:207-771-5755
Is Sole Proprietor?:No
Enumeration Date:2010-10-15
Last Update Date:2010-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MELC6131101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health