Provider Demographics
NPI:1386660215
Name:ADLER, BEVERLY S (PHD)
Entity Type:Individual
Prefix:
First Name:BEVERLY
Middle Name:S
Last Name:ADLER
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 1:2280 GRAND AVE
Mailing Address - Street 2:SUITE 312
Mailing Address - City:BALDWIN
Mailing Address - State:NY
Mailing Address - Zip Code:11510-3164
Mailing Address - Country:US
Mailing Address - Phone:516-378-6676
Mailing Address - Fax:
Practice Address - Street 1:2280 GRAND AVE
Practice Address - Street 2:SUITE 312
Practice Address - City:BALDWIN
Practice Address - State:NY
Practice Address - Zip Code:11510-3164
Practice Address - Country:US
Practice Address - Phone:516-378-6676
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY009813103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01974161Medicaid
NY01974161Medicaid
NYS87808Medicare UPIN