Provider Demographics
NPI:1750876348
Name:BEYLERIAN, MISTY ANN (CADC)
Entity type:Individual
Prefix:
First Name:MISTY
Middle Name:ANN
Last Name:BEYLERIAN
Suffix:
Gender:F
Credentials:CADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:235 CENTER ST
Mailing Address - Street 2:
Mailing Address - City:BREWER
Mailing Address - State:ME
Mailing Address - Zip Code:04412-1961
Mailing Address - Country:US
Mailing Address - Phone:207-561-9496
Mailing Address - Fax:
Practice Address - Street 1:235 CENTER ST
Practice Address - Street 2:
Practice Address - City:BREWER
Practice Address - State:ME
Practice Address - Zip Code:04412-1961
Practice Address - Country:US
Practice Address - Phone:207-561-9496
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-06-26
Last Update Date:2018-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME101YA0400XMedicaid