Provider Demographics
NPI:1164072146
Name:BEAZELL, STEWART (PSYD)
Entity type:Individual
Prefix:DR
First Name:STEWART
Middle Name:
Last Name:BEAZELL
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 1:11260 ROGER BACON DR STE 204
Mailing Address - Street 2:
Mailing Address - City:RESTON
Mailing Address - State:VA
Mailing Address - Zip Code:20190-5252
Mailing Address - Country:US
Mailing Address - Phone:703-239-3531
Mailing Address - Fax:703-464-0507
Practice Address - Street 1:11260 ROGER BACON DR STE 204
Practice Address - Street 2:
Practice Address - City:RESTON
Practice Address - State:VA
Practice Address - Zip Code:20190-5252
Practice Address - Country:US
Practice Address - Phone:703-239-3531
Practice Address - Fax:703-464-0507
Is Sole Proprietor?:Yes
Enumeration Date:2019-09-12
Last Update Date:2022-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0810007311103TC0700X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program