Provider Demographics
NPI:1306464573
Name:BEATTIE, MARGOT T
Entity type:Individual
Prefix:DR
First Name:MARGOT
Middle Name:T
Last Name:BEATTIE
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 1:7800 EUREKA AVE
Mailing Address - Street 2:
Mailing Address - City:EL CERRITO
Mailing Address - State:CA
Mailing Address - Zip Code:94530-3305
Mailing Address - Country:US
Mailing Address - Phone:510-387-1520
Mailing Address - Fax:
Practice Address - Street 1:2000 HEARST AVE STE 208
Practice Address - Street 2:
Practice Address - City:BERKELEY
Practice Address - State:CA
Practice Address - Zip Code:94709-2260
Practice Address - Country:US
Practice Address - Phone:510-387-1520
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-07-13
Last Update Date:2020-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY10550103TP0814X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TP0814XBehavioral Health & Social Service ProvidersPsychologistPsychoanalysis