Provider Demographics
NPI:1851348254
Name:BEYDA, ELLEN (PSYD)
Entity Type:Individual
Prefix:
First Name:ELLEN
Middle Name:
Last Name:BEYDA
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:311 15TH ST
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11215-5005
Mailing Address - Country:US
Mailing Address - Phone:917-538-5104
Mailing Address - Fax:
Practice Address - Street 1:115 W 27TH ST
Practice Address - Street 2:4
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10001-6217
Practice Address - Country:US
Practice Address - Phone:917-538-5104
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-30
Last Update Date:2014-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY014761-1103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02407243Medicaid
NY02407243Medicaid
NYA400096829Medicare PIN