Healthcare Provider Details

I. General information

NPI: 1477866911
Provider Name (Legal Business Name): DONOVAN W. BEDWARD LCSW
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/26/2010
Last Update Date: 10/25/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

160 ROUTE 9
BAYVILLE NJ
08721-1229
US

IV. Provider business mailing address

160 ROUTE 9
BAYVILLE NJ
08721-1229
US

V. Phone/Fax

Practice location:
  • Phone: 732-349-5550
  • Fax: 732-349-6702
Mailing address:
  • Phone: 732-349-5550
  • Fax: 732-349-6702

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number44SC05523600
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: