Healthcare Provider Details

I. General information

NPI: 1023253655
Provider Name (Legal Business Name): KRISTIN DIANE BEINDORF LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/11/2008
Last Update Date: 12/11/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1303 BELLEFONTAINE AVE
LIMA OH
45804-3109
US

IV. Provider business mailing address

1303 BELLEFONTAINE AVE
LIMA OH
45804-3109
US

V. Phone/Fax

Practice location:
  • Phone: 419-222-5788
  • Fax: 419-227-9794
Mailing address:
  • Phone: 419-222-5788
  • Fax: 419-227-9794

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number0904006810
License Number StateVA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: