Provider Demographics
NPI:1639834278
Name:BEELER, BRANDON E (PSYD)
Entity Type:Individual
Prefix:DR
First Name:BRANDON
Middle Name:E
Last Name:BEELER
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 1:515 PARK PL APT 4A
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11238-4684
Mailing Address - Country:US
Mailing Address - Phone:917-363-5665
Mailing Address - Fax:
Practice Address - Street 1:515 PARK PL APT 4A
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11238-4684
Practice Address - Country:US
Practice Address - Phone:917-363-5665
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-11-08
Last Update Date:2021-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY024656103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical