Provider Demographics
NPI:1700271145
Name:BEAVER, BRAELYN ELIZABETH (MED, BSL)
Entity Type:Individual
Prefix:
First Name:BRAELYN
Middle Name:ELIZABETH
Last Name:BEAVER
Suffix:
Gender:F
Credentials:MED, BSL
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:P.O. BOX 456
Mailing Address - Street 2:
Mailing Address - City:ELVERSON
Mailing Address - State:PA
Mailing Address - Zip Code:19520
Mailing Address - Country:US
Mailing Address - Phone:518-466-5643
Mailing Address - Fax:
Practice Address - Street 1:52D MUIRFIELD DR
Practice Address - Street 2:
Practice Address - City:READING
Practice Address - State:PA
Practice Address - Zip Code:19607-3352
Practice Address - Country:US
Practice Address - Phone:518-466-5643
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-04-02
Last Update Date:2015-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PABH002647103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst