Provider Demographics
NPI:1619799772
Name:BEACH, LOUISE K (CNS)
Entity type:Individual
Prefix:
First Name:LOUISE
Middle Name:K
Last Name:BEACH
Suffix:
Gender:F
Credentials:CNS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:33 ROMER AVE
Mailing Address - Street 2:
Mailing Address - City:PLEASANTVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:10570-3154
Mailing Address - Country:US
Mailing Address - Phone:914-260-7548
Mailing Address - Fax:
Practice Address - Street 1:42 WHEELER AVE STE 207
Practice Address - Street 2:
Practice Address - City:PLEASANTVILLE
Practice Address - State:NY
Practice Address - Zip Code:10570-3019
Practice Address - Country:US
Practice Address - Phone:914-260-7548
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-10-29
Last Update Date:2024-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYCNS17603133N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133N00000XDietary & Nutritional Service ProvidersNutritionist