Provider Demographics
NPI:1992906036
Name:BEVERIDGE, ISABELLE (PHD, COTA)
Entity type:Individual
Prefix:DR
First Name:ISABELLE
Middle Name:
Last Name:BEVERIDGE
Suffix:
Gender:F
Credentials:PHD, COTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:475 ECHO LAKE DR
Mailing Address - Street 2:
Mailing Address - City:BANGOR
Mailing Address - State:PA
Mailing Address - Zip Code:18013-5342
Mailing Address - Country:US
Mailing Address - Phone:610-599-5054
Mailing Address - Fax:610-599-8805
Practice Address - Street 1:600 S LIVINGSTON AVE
Practice Address - Street 2:SUITE 210
Practice Address - City:LIVINGSTON
Practice Address - State:NJ
Practice Address - Zip Code:07039-5419
Practice Address - Country:US
Practice Address - Phone:800-278-0332
Practice Address - Fax:973-740-9007
Is Sole Proprietor?:No
Enumeration Date:2007-05-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ46TA09024600174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist