Healthcare Provider Details

I. General information

NPI: 1518268291
Provider Name (Legal Business Name): JENNIE LYNN BEUER LCSW, MSW, RPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/11/2010
Last Update Date: 10/25/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

390 PONDELLA RD SUITE 9
NORTH FORT MYERS FL
33903-4340
US

IV. Provider business mailing address

390 PONDELLA RD SUITE 9
NORTH FORT MYERS FL
33903-4340
US

V. Phone/Fax

Practice location:
  • Phone: 239-652-0260
  • Fax: 239-652-0146
Mailing address:
  • Phone: 239-652-0260
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number9923004
License Number StateCO
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberSW11698
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: