Provider Demographics
NPI:1548546203
Name:BEASLEY, CORTNEY R (PSYD)
Entity type:Individual
Prefix:
First Name:CORTNEY
Middle Name:R
Last Name:BEASLEY
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 1:625 MARKET ST FL 15
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94105-3316
Mailing Address - Country:US
Mailing Address - Phone:415-360-3833
Mailing Address - Fax:617-414-1975
Practice Address - Street 1:625 MARKET ST FL 15
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94105-3316
Practice Address - Country:US
Practice Address - Phone:415-360-3833
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-10-26
Last Update Date:2020-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA31751103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical