Healthcare Provider Details

I. General information

NPI: 1952544090
Provider Name (Legal Business Name): BETH ANNE LUCIA LSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/18/2009
Last Update Date: 04/21/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

218A SUNSET RD SCREENING, CRISIS & INTERVENTION PROGRAM (SCIP)
WILLINGBORO NJ
08046-1110
US

IV. Provider business mailing address

1289 ROUTE 38
HAINESPORT NJ
08036-2730
US

V. Phone/Fax

Practice location:
  • Phone: 609-835-6180
  • Fax: 609-835-7962
Mailing address:
  • Phone: 609-267-5656
  • Fax: 609-267-8892

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number44SL04591200
License Number StateNJ
# 2
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number44SL04591200
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: