Provider Demographics
NPI:1558586966
Name:BEAN, STEPHANIE (CMT)
Entity Type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:
Last Name:BEAN
Suffix:
Gender:F
Credentials:CMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8905 48TH AVE
Mailing Address - Street 2:
Mailing Address - City:COLLEGE PARK
Mailing Address - State:MD
Mailing Address - Zip Code:20740-2003
Mailing Address - Country:US
Mailing Address - Phone:410-869-0908
Mailing Address - Fax:
Practice Address - Street 1:8905 48TH AVE
Practice Address - Street 2:
Practice Address - City:COLLEGE PARK
Practice Address - State:MD
Practice Address - Zip Code:20740-2003
Practice Address - Country:US
Practice Address - Phone:410-869-0908
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDM03096174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist