Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XM0800X | Mental Health | 018244 | NY |
NPI | 1336652783 |
---|---|
Provider Name | Mrs. Jocelyn Terese Beach |
First Address | Albion, NY 14411-9371 |
Second Address | Rochester, NY 14620-3005 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 08/11/2017 |
Last Update Date | 08/11/2017 |