Provider Demographics
NPI:1952058273
Name:BEACH, SHARON (LISW-S)
Entity Type:Individual
Prefix:
First Name:SHARON
Middle Name:
Last Name:BEACH
Suffix:
Gender:F
Credentials:LISW-S
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:137 N MEADOWCROFT DR
Mailing Address - Street 2:
Mailing Address - City:AKRON
Mailing Address - State:OH
Mailing Address - Zip Code:44313-6253
Mailing Address - Country:US
Mailing Address - Phone:330-396-1563
Mailing Address - Fax:
Practice Address - Street 1:100 30TH ST NW
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:OH
Practice Address - Zip Code:44709-3100
Practice Address - Country:US
Practice Address - Phone:330-396-1563
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-03-07
Last Update Date:2022-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH1101082-SUPV101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Single Specialty