Provider Demographics
NPI:1437123577
Name:NEIMAN, BETH L (PHD)
Entity Type:Individual
Prefix:DR
First Name:BETH
Middle Name:L
Last Name:NEIMAN
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 1:47 FELLSMERE RD
Mailing Address - Street 2:
Mailing Address - City:NEWTON
Mailing Address - State:MA
Mailing Address - Zip Code:02459-1339
Mailing Address - Country:US
Mailing Address - Phone:617-527-4212
Mailing Address - Fax:617-527-1664
Practice Address - Street 1:47 FELLSMERE RD
Practice Address - Street 2:
Practice Address - City:NEWTON
Practice Address - State:MA
Practice Address - Zip Code:02459-1339
Practice Address - Country:US
Practice Address - Phone:617-527-4212
Practice Address - Fax:617-527-1664
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-15
Last Update Date:2008-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA6494103TC0700X
MA282824103TS0200X
MA222103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool
No103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA138708000OtherMAGELLAN
MA0503193Medicaid
MAW06341OtherBLUE CROSS BLUE SHIELD
MA24497OtherCIGNA BEHAVIORAL HEALTH
MAW06341OtherBLUE CROSS BLUE SHIELD
MANE A38224Medicare ID - Type Unspecified