Provider Demographics
NPI:1760997829
Name:BEEROM, ERIN LARK
Entity Type:Individual
Prefix:
First Name:ERIN
Middle Name:LARK
Last Name:BEEROM
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 1:12221 E COLONIAL DR APT 2105
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32826-4765
Mailing Address - Country:US
Mailing Address - Phone:407-730-5969
Mailing Address - Fax:
Practice Address - Street 1:12221 E COLONIAL DR APT 2105
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32826-4765
Practice Address - Country:US
Practice Address - Phone:407-730-5969
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-12-11
Last Update Date:2021-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician