Healthcare Provider Details

I. General information

NPI: 1720196280
Provider Name (Legal Business Name): LINDA THERESA BEAM LCSWC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/26/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

600 PROVIDENCE RD THE COUNSELING CENTER
BALTIMORE MD
21286-5503
US

IV. Provider business mailing address

600 PROVIDENCE RD THE COUNSELING CENTER
BALTIMORE MD
21286-5503
US

V. Phone/Fax

Practice location:
  • Phone: 410-583-7443
  • Fax: 410-583-0711
Mailing address:
  • Phone: 410-583-7443
  • Fax: 410-583-0711

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number10245
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: