Provider Demographics
NPI:1891184909
Name:BEACON THERAPIES LLC
Entity Type:Organization
Organization Name:BEACON THERAPIES LLC
Other - Org Name:BEACON THERAPIES INC.
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:EVELYN
Authorized Official - Middle Name:MARTHA
Authorized Official - Last Name:RODRIGUEZ
Authorized Official - Suffix:
Authorized Official - Credentials:MS CCC-SLP
Authorized Official - Phone:617-512-4139
Mailing Address - Street 1:1051 BEACON ST
Mailing Address - Street 2:SUITE 511
Mailing Address - City:BROOKLINE
Mailing Address - State:MA
Mailing Address - Zip Code:02446-5685
Mailing Address - Country:US
Mailing Address - Phone:617-512-4139
Mailing Address - Fax:
Practice Address - Street 1:1051 BEACON ST
Practice Address - Street 2:SUITE 511
Practice Address - City:BROOKLINE
Practice Address - State:MA
Practice Address - Zip Code:02446-5685
Practice Address - Country:US
Practice Address - Phone:617-512-4139
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-01-13
Last Update Date:2023-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA4340235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Multi-Specialty