Provider Demographics
NPI:1689205213
Name:BEATON, MINERVA
Entity Type:Individual
Prefix:
First Name:MINERVA
Middle Name:
Last Name:BEATON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:101 SAINT FELIX ST
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11217-1432
Mailing Address - Country:US
Mailing Address - Phone:913-742-3366
Mailing Address - Fax:
Practice Address - Street 1:924 ROGERS AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11226-9602
Practice Address - Country:US
Practice Address - Phone:913-742-3366
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-02-02
Last Update Date:2020-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional