Healthcare Provider Details

I. General information

NPI: 1871415984
Provider Name (Legal Business Name): BE4AU
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/29/2026
Last Update Date: 07/29/2026
Certification Date: 07/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

110 AVON CT
MALVERN PA
19355-8526
US

IV. Provider business mailing address

110 AVON CT
MALVERN PA
19355-8526
US

V. Phone/Fax

Practice location:
  • Phone: 267-257-4488
  • Fax:
Mailing address:
  • Phone: 267-257-4488
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code1041S0200X
TaxonomySchool Social Worker
License Number
License Number State

VIII. Authorized Official

Name: MALANNA SIMMONS
Title or Position: OWNER
Credential: LCSW
Phone: 612-413-4087