Healthcare Provider Details

I. General information

NPI: 1376103101
Provider Name (Legal Business Name): ANGELA LEA BEIDELMAN MSW, LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/14/2019
Last Update Date: 05/28/2021
Certification Date: 05/24/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1350 HICKORY ST
MELBOURNE FL
32901-3278
US

IV. Provider business mailing address

4501 BELLALUNA DR
WEST MELBOURNE FL
32904-3101
US

V. Phone/Fax

Practice location:
  • Phone: 321-434-7000
  • Fax:
Mailing address:
  • Phone: 850-284-9822
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberISW13211
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberSW18113
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: