Provider Demographics
NPI:1598583262
Name:BEALTS, JANELLE
Entity type:Individual
Prefix:
First Name:JANELLE
Middle Name:
Last Name:BEALTS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:JANELLE
Other - Middle Name:
Other - Last Name:BENJAMIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:20530 WOODBRIDGE DR
Mailing Address - Street 2:
Mailing Address - City:HAGERSTOWN
Mailing Address - State:MD
Mailing Address - Zip Code:21742-3111
Mailing Address - Country:US
Mailing Address - Phone:904-382-0704
Mailing Address - Fax:
Practice Address - Street 1:20530 WOODBRIDGE DR
Practice Address - Street 2:
Practice Address - City:HAGERSTOWN
Practice Address - State:MD
Practice Address - Zip Code:21742-3111
Practice Address - Country:US
Practice Address - Phone:904-382-0704
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-10-01
Last Update Date:2024-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician