Healthcare Provider Details

I. General information

NPI: 1275892143
Provider Name (Legal Business Name): MICHAEL THOMAS BEATTY LCSW
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/11/2012
Last Update Date: 06/25/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 NORTHPOINTE CIR SUITE 306
SEVEN FIELDS PA
16046-7851
US

IV. Provider business mailing address

100 NORTHPOINTE CIR SUITE 306
SEVEN FIELDS PA
16046-7851
US

V. Phone/Fax

Practice location:
  • Phone: 724-772-4848
  • Fax: 724-772-4888
Mailing address:
  • Phone: 724-772-4848
  • Fax: 724-772-4888

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberCW017770
License Number StatePA

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: