Healthcare Provider Details

I. General information

NPI: 1750148706
Provider Name (Legal Business Name): BRIANNA BEAVER LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/05/2024
Last Update Date: 08/12/2025
Certification Date: 08/12/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 KNUTH RD STE 200G
BOYNTON BEACH FL
33436-4693
US

IV. Provider business mailing address

4832 ESEDRA CT APT 103
LAKE WORTH FL
33467-5004
US

V. Phone/Fax

Practice location:
  • Phone: 708-212-8317
  • Fax:
Mailing address:
  • Phone: 708-212-8317
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberSW24998
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: