Provider Demographics
NPI:1730307794
Name:STRZOK, BEVERLY J (PHD)
Entity Type:Individual
Prefix:DR
First Name:BEVERLY
Middle Name:J
Last Name:STRZOK
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:49 DEERING ST
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:ME
Mailing Address - Zip Code:04101-2211
Mailing Address - Country:US
Mailing Address - Phone:207-846-9012
Mailing Address - Fax:207-846-9012
Practice Address - Street 1:49 DEERING ST
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:ME
Practice Address - Zip Code:04101-2211
Practice Address - Country:US
Practice Address - Phone:207-846-9012
Practice Address - Fax:207-846-9012
Is Sole Proprietor?:No
Enumeration Date:2007-04-23
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEPS735103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical