Provider Demographics
NPI:1659679520
Name:BEITMAN, JAYNE ELLEN
Entity Type:Individual
Prefix:
First Name:JAYNE
Middle Name:ELLEN
Last Name:BEITMAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:JAYNE
Other - Middle Name:ELLEN
Other - Last Name:BEITMAN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MA
Mailing Address - Street 1:111 EDGARTOWN ROAD
Mailing Address - Street 2:
Mailing Address - City:VINEYARD HAVEN
Mailing Address - State:MA
Mailing Address - Zip Code:02568
Mailing Address - Country:US
Mailing Address - Phone:508-693-7900
Mailing Address - Fax:508-696-0401
Practice Address - Street 1:111EDGARTOWN RAOD
Practice Address - Street 2:MARTHA'S VINEYARD COMMUNITY SERVICES
Practice Address - City:VINEYARD HAVEN
Practice Address - State:MA
Practice Address - Zip Code:02568
Practice Address - Country:US
Practice Address - Phone:508-693-7900
Practice Address - Fax:508-696-0401
Is Sole Proprietor?:Yes
Enumeration Date:2011-03-02
Last Update Date:2011-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health