Healthcare Provider Details

I. General information

NPI: 1457601049
Provider Name (Legal Business Name): MR. MICHAEL A BEYER
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/11/2012
Last Update Date: 05/26/2026
Certification Date: 05/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16 RITTER ST
SAN RAFAEL CA
94901-3323
US

IV. Provider business mailing address

PO BOX 3517
SAN RAFAEL CA
94912-3517
US

V. Phone/Fax

Practice location:
  • Phone: 415-457-8182
  • Fax:
Mailing address:
  • Phone: 415-457-8182
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number138713
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: