Provider Demographics
NPI:1861869943
Name:BEACH, ELIZABETH BRADY (NCC, LAC, BCBA)
Entity type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:BRADY
Last Name:BEACH
Suffix:
Gender:F
Credentials:NCC, LAC, BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1100 MAXWELL LN
Mailing Address - Street 2:UNIT 610
Mailing Address - City:HOBOKEN
Mailing Address - State:NJ
Mailing Address - Zip Code:07030-6882
Mailing Address - Country:US
Mailing Address - Phone:317-670-7490
Mailing Address - Fax:
Practice Address - Street 1:1100 MAXWELL LN
Practice Address - Street 2:UNIT 610
Practice Address - City:HOBOKEN
Practice Address - State:NJ
Practice Address - Zip Code:07030-6882
Practice Address - Country:US
Practice Address - Phone:317-670-7490
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-08-25
Last Update Date:2015-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ37AC00064400101Y00000X
NJ705548101YS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YS0200XBehavioral Health & Social Service ProvidersCounselorSchool