Provider Demographics
NPI:1457411621
Name:BEEMAN, EDNA ACKERLY (MSW, DSW)
Entity Type:Individual
Prefix:DR
First Name:EDNA
Middle Name:ACKERLY
Last Name:BEEMAN
Suffix:
Gender:F
Credentials:MSW, DSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15 VAN ALST PL
Mailing Address - Street 2:
Mailing Address - City:MELVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:11747-1224
Mailing Address - Country:US
Mailing Address - Phone:631-351-1925
Mailing Address - Fax:
Practice Address - Street 1:10 GRACE AVE
Practice Address - Street 2:
Practice Address - City:GREAT NECK
Practice Address - State:NY
Practice Address - Zip Code:11021-2423
Practice Address - Country:US
Practice Address - Phone:516-466-6224
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR0134801041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYN85261, N85262OtherNSLIJHS-EMPIRE BLUE CROSS
NYN85261, N85262OtherNSLIJHS-EMPIRE BLUE CROSS