Provider Demographics
NPI:1811240732
Name:PERSAUD, BEENA (PSYD)
Entity type:Individual
Prefix:
First Name:BEENA
Middle Name:
Last Name:PERSAUD
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:167 HUNT CLUB DR APT 2B
Mailing Address - Street 2:
Mailing Address - City:COPLEY
Mailing Address - State:OH
Mailing Address - Zip Code:44321-2730
Mailing Address - Country:US
Mailing Address - Phone:417-343-5132
Mailing Address - Fax:
Practice Address - Street 1:167 HUNT CLUB DR APT 2B
Practice Address - Street 2:
Practice Address - City:COPLEY
Practice Address - State:OH
Practice Address - Zip Code:44321-2730
Practice Address - Country:US
Practice Address - Phone:417-343-5132
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-10-16
Last Update Date:2012-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH6947103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical