MEDICARE: DR. CHARLES L BEALE ED.D

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103TC1900X	Counseling Psychologist	122	DE

General Provider Information

NPI Number	:	1073636965
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CHARLES L BEALE ED.D

Provider Business Mailing Address
First Line	:	508 RIDGE DR
Second Line	:
City	:	LINCOLN UNIVERSITY
State	:	PA
Zip	:	19352-9012
Country	:	US
Telephone Number	:	610-869-4436
Fax Number	:	610-869-4428

Provider Business Practice Location Address
First Line	:	62 N CHAPEL ST
Second Line	:	SUITE 203
City	:	NEWARK
State	:	DE
Zip	:	19711-2238
Country	:	US
Telephone Number	:	302-369-9999
Fax Number	:	610-869-4428

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/07/2007
Last Update Date	:	07/08/2007

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