Healthcare Provider Details

I. General information

NPI: 1093063588
Provider Name (Legal Business Name): JESSICA BEU LSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/15/2012
Last Update Date: 01/22/2021
Certification Date: 01/22/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

617 N TAYLOR AVE
PITTSBURGH PA
15212-4540
US

IV. Provider business mailing address

617 N TAYLOR AVE
PITTSBURGH PA
15212-4540
US

V. Phone/Fax

Practice location:
  • Phone: 412-334-5975
  • Fax:
Mailing address:
  • Phone: 412-334-5975
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberSW125153
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberCW021054
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: