Provider Demographics
NPI:1710420989
Name:BEESO, EDWARD ALBERT JR
Entity Type:Individual
Prefix:
First Name:EDWARD
Middle Name:ALBERT
Last Name:BEESO
Suffix:JR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:32 DUXBURY RD
Mailing Address - Street 2:
Mailing Address - City:WORCESTER
Mailing Address - State:MA
Mailing Address - Zip Code:01605-2129
Mailing Address - Country:US
Mailing Address - Phone:508-304-8779
Mailing Address - Fax:
Practice Address - Street 1:411 CHANDLER ST
Practice Address - Street 2:
Practice Address - City:WORCESTER
Practice Address - State:MA
Practice Address - Zip Code:01602-3339
Practice Address - Country:US
Practice Address - Phone:508-799-0688
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-11-21
Last Update Date:2016-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor