Provider Demographics
NPI:1851633721
Name:MUSGRAVE, BEVERLY ANNE (MENTAL HEALTH)
Entity Type:Individual
Prefix:DR
First Name:BEVERLY
Middle Name:ANNE
Last Name:MUSGRAVE
Suffix:
Gender:F
Credentials:MENTAL HEALTH
Other - Prefix:
Other - First Name:BEVERLY
Other - Middle Name:ANNE
Other - Last Name:MUSGRAVE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PH D
Mailing Address - Street 1:210 E 15TH ST APT 8P
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10003-3926
Mailing Address - Country:US
Mailing Address - Phone:212-477-2328
Mailing Address - Fax:
Practice Address - Street 1:210 E 15TH ST
Practice Address - Street 2:8P
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10003-3922
Practice Address - Country:US
Practice Address - Phone:212-477-2328
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-03-19
Last Update Date:2013-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY001090-1101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health