Provider Demographics
NPI:1710215298
Name:BARON, BETH ALISA (CMTPT, CMT)
Entity Type:Individual
Prefix:MS
First Name:BETH
Middle Name:ALISA
Last Name:BARON
Suffix:
Gender:F
Credentials:CMTPT, CMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2428 DWIGHT WAY STE 9
Mailing Address - Street 2:
Mailing Address - City:BERKELEY
Mailing Address - State:CA
Mailing Address - Zip Code:94704-2399
Mailing Address - Country:US
Mailing Address - Phone:510-551-9539
Mailing Address - Fax:
Practice Address - Street 1:2428 DWIGHT WAY STE 9
Practice Address - Street 2:
Practice Address - City:BERKELEY
Practice Address - State:CA
Practice Address - Zip Code:94704-2399
Practice Address - Country:US
Practice Address - Phone:510-551-9539
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-11-22
Last Update Date:2009-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist