Provider Demographics
NPI:1427783604
Name:BEAUMONT-TYNES, ALDEAN (PSYD)
Entity type:Individual
Prefix:DR
First Name:ALDEAN
Middle Name:
Last Name:BEAUMONT-TYNES
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:62 STANFORD AVE
Mailing Address - Street 2:
Mailing Address - City:WEST ORANGE
Mailing Address - State:NJ
Mailing Address - Zip Code:07052-2048
Mailing Address - Country:US
Mailing Address - Phone:917-804-9996
Mailing Address - Fax:
Practice Address - Street 1:62 STANFORD AVE
Practice Address - Street 2:
Practice Address - City:WEST ORANGE
Practice Address - State:NJ
Practice Address - Zip Code:07052-2048
Practice Address - Country:US
Practice Address - Phone:917-804-9996
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-07-20
Last Update Date:2022-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ35SI00673200103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist