Provider Demographics
NPI:1376542407
Name:BEARDMORE, ROGER O (PSYD)
Entity Type:Individual
Prefix:DR
First Name:ROGER
Middle Name:O
Last Name:BEARDMORE
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8040 CARLSON RD
Mailing Address - Street 2:PO BOX 6600
Mailing Address - City:HARRISBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17112-9706
Mailing Address - Country:US
Mailing Address - Phone:717-671-6566
Mailing Address - Fax:888-296-4002
Practice Address - Street 1:8040 CARLSON RD
Practice Address - Street 2:
Practice Address - City:HARRISBURG
Practice Address - State:PA
Practice Address - Zip Code:17112-9706
Practice Address - Country:US
Practice Address - Phone:717-671-6566
Practice Address - Fax:888-296-4002
Is Sole Proprietor?:No
Enumeration Date:2005-07-20
Last Update Date:2008-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPS015614103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist