Provider Demographics
NPI:1649886581
Name:BEASLEY, COLIE NATHANUAL
Entity type:Individual
Prefix:
First Name:COLIE
Middle Name:NATHANUAL
Last Name:BEASLEY
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1059 TREMONT ST STE 2
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02120-2193
Mailing Address - Country:US
Mailing Address - Phone:857-544-1320
Mailing Address - Fax:
Practice Address - Street 1:37 BOWDOIN ST
Practice Address - Street 2:
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02114-4201
Practice Address - Country:US
Practice Address - Phone:857-544-1320
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-09-16
Last Update Date:2020-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator