Healthcare Provider Details

I. General information

NPI: 1780146217
Provider Name (Legal Business Name): YAZMIN BEEKS LGSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/03/2019
Last Update Date: 04/03/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9015 WOODYARD RD STE 109
CLINTON MD
20735-4226
US

IV. Provider business mailing address

3360 HUNTLEY SQUARE DR APT A1
TEMPLE HILLS MD
20748-6223
US

V. Phone/Fax

Practice location:
  • Phone: 301-541-0963
  • Fax:
Mailing address:
  • Phone: 908-414-5610
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number24066
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: