Patty Beaver, LSW

Primary specialty

Mental Health CounselorTaxonomy code 101YM0800X

License

11742 Issued in PR

Practice address

11201 Benton St
Loma Linda, CA 92357-5703

Phone

(909) 674-2794

NPI assigned

Jan 28, 2016

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1453939200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1666224000000",
    "number": "1003273590",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11201 BENTON ST",
            "city": "LOMA LINDA",
            "state": "CA",
            "postal_code": "923571000",
            "telephone_number": "909-674-2794"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11201 BENTON ST",
            "city": "LOMA LINDA",
            "state": "CA",
            "postal_code": "923575703",
            "telephone_number": "909-674-2794"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BEAVER",
        "first_name": "PATTY",
        "credential": "LSW",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2016-01-28",
        "last_updated": "2022-10-20",
        "certification_date": "2022-10-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "PR",
            "license": "11742",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Samuel Baz, M.D.
• Victoria L Bazanos, DNP
• Bbddd, Inc
• Kraig Beardemphl, MDIV
• Beaver Medical Group
• Maria Patricia Becerra Garcia, DDS
• Joel Kazuo Miyakawa Beck, DO
• Priscilla Jacqueline Becker
• Ryan John Becker, DDS
• Derran George Bedward, MD

• All providers in Loma Linda, CA
• Mental Health Counselor in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 20, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.