Provider Demographics
NPI:1285406066
Name:BEAMING MIND PSYCHOLOGY LLC
Entity type:Organization
Organization Name:BEAMING MIND PSYCHOLOGY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:VERONICA
Authorized Official - Middle Name:PATRICIA
Authorized Official - Last Name:MEDINA
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:484-408-4646
Mailing Address - Street 1:14370 59TH CIR E
Mailing Address - Street 2:
Mailing Address - City:BRADENTON
Mailing Address - State:FL
Mailing Address - Zip Code:34211-0740
Mailing Address - Country:US
Mailing Address - Phone:941-842-3837
Mailing Address - Fax:
Practice Address - Street 1:1101 TAMIAMI TRL S STE 215A-1
Practice Address - Street 2:
Practice Address - City:VENICE
Practice Address - State:FL
Practice Address - Zip Code:34285-4133
Practice Address - Country:US
Practice Address - Phone:941-842-3837
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-10-25
Last Update Date:2024-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health
No261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health