Provider Demographics
NPI:1124836804
Name:BEANER, DAIJAH
Entity type:Individual
Prefix:
First Name:DAIJAH
Middle Name:
Last Name:BEANER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2427 RICHMOND WAY
Mailing Address - Street 2:
Mailing Address - City:WALDORF
Mailing Address - State:MD
Mailing Address - Zip Code:20603-3801
Mailing Address - Country:US
Mailing Address - Phone:240-682-1808
Mailing Address - Fax:
Practice Address - Street 1:2427 RICHMOND WAY
Practice Address - Street 2:
Practice Address - City:WALDORF
Practice Address - State:MD
Practice Address - Zip Code:20603-3801
Practice Address - Country:US
Practice Address - Phone:240-682-1808
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-12-26
Last Update Date:2025-01-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician