Provider Demographics
NPI:1437021813
Name:EAST BEACH PSYCHOLOGICAL SERVICES, P.C.
Entity type:Organization
Organization Name:EAST BEACH PSYCHOLOGICAL SERVICES, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:ASHLEY
Authorized Official - Middle Name:
Authorized Official - Last Name:KANE
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:757-796-5851
Mailing Address - Street 1:4490 PLEASANT AVE UNIT B
Mailing Address - Street 2:
Mailing Address - City:NORFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23518-1821
Mailing Address - Country:US
Mailing Address - Phone:757-796-5851
Mailing Address - Fax:
Practice Address - Street 1:4490 PLEASANT AVE UNIT B
Practice Address - Street 2:
Practice Address - City:NORFOLK
Practice Address - State:VA
Practice Address - Zip Code:23518-1821
Practice Address - Country:US
Practice Address - Phone:757-796-5851
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-09-23
Last Update Date:2025-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Multi-Specialty
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty