Provider Demographics
NPI:1306246376
Name:BEACON PSYCHOLOGICAL SERVICES
Entity type:Organization
Organization Name:BEACON PSYCHOLOGICAL SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:SCOTT
Authorized Official - Middle Name:PEALE
Authorized Official - Last Name:MOONEY
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:315-342-5941
Mailing Address - Street 1:317 W 1ST ST
Mailing Address - Street 2:SUITE 112
Mailing Address - City:OSWEGO
Mailing Address - State:NY
Mailing Address - Zip Code:13126-3623
Mailing Address - Country:US
Mailing Address - Phone:315-342-5941
Mailing Address - Fax:315-343-2915
Practice Address - Street 1:317 W 1ST ST
Practice Address - Street 2:SUITE 112
Practice Address - City:OSWEGO
Practice Address - State:NY
Practice Address - Zip Code:13126-3623
Practice Address - Country:US
Practice Address - Phone:315-342-5941
Practice Address - Fax:315-343-2915
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-08-27
Last Update Date:2014-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty
No101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Multi-Specialty
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
No363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Multi-Specialty