Healthcare Provider Details

I. General information

NPI: 1659049211
Provider Name (Legal Business Name): VINCENT EVERETT BEARD LLBSW
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/31/2021
Last Update Date: 08/31/2021
Certification Date: 08/31/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

445 LEDYARD STREET
DETROIT MI
48201
US

IV. Provider business mailing address

445 LEDYARD STREET
DETROIT MI
48201
US

V. Phone/Fax

Practice location:
  • Phone: 313-962-9446
  • Fax: 313-962-6395
Mailing address:
  • Phone: 313-962-9446
  • Fax: 313-962-6395

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number6802091149
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: