Provider Demographics
NPI:1942584008
Name:BEASLEY, SHAWNA JANEL (LMSW)
Entity Type:Individual
Prefix:MS
First Name:SHAWNA
Middle Name:JANEL
Last Name:BEASLEY
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:135 EINSTEIN LOOP
Mailing Address - Street 2:# 46
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10475-4998
Mailing Address - Country:US
Mailing Address - Phone:718-320-3082
Mailing Address - Fax:718-379-4348
Practice Address - Street 1:2250 HOLLAND AVE
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10467-9402
Practice Address - Country:US
Practice Address - Phone:718-798-7801
Practice Address - Fax:718-798-7644
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-06
Last Update Date:2013-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY080932101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health