Provider Demographics
NPI:1114740487
Name:BEACON PSYCHIATRY PLLC
Entity type:Organization
Organization Name:BEACON PSYCHIATRY PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:TARA
Authorized Official - Middle Name:
Authorized Official - Last Name:CONKLIN
Authorized Official - Suffix:
Authorized Official - Credentials:PMHNP
Authorized Official - Phone:203-858-1690
Mailing Address - Street 1:6 LIBERTY SQ # 97524
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02109-5800
Mailing Address - Country:US
Mailing Address - Phone:617-575-9830
Mailing Address - Fax:
Practice Address - Street 1:5 BRISTOL DR
Practice Address - Street 2:STE 3F
Practice Address - City:SOUTH EASTON
Practice Address - State:MA
Practice Address - Zip Code:02375
Practice Address - Country:US
Practice Address - Phone:617-575-9830
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-11-05
Last Update Date:2024-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes364SP0808XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPsychiatric/Mental HealthGroup - Single Specialty