Provider Demographics
NPI:1215069935
Name:LONDON, BETH (LCAT)
Entity type:Individual
Prefix:
First Name:BETH
Middle Name:
Last Name:LONDON
Suffix:
Gender:F
Credentials:LCAT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:612 CARROLL ST
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11215-1118
Mailing Address - Country:US
Mailing Address - Phone:718-488-0100
Mailing Address - Fax:718-488-0129
Practice Address - Street 1:199 JAY ST
Practice Address - Street 2:2ND FL
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11201-1907
Practice Address - Country:US
Practice Address - Phone:718-488-0100
Practice Address - Fax:718-488-0129
Is Sole Proprietor?:No
Enumeration Date:2007-03-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY000111221700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes221700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersArt Therapist