Healthcare Provider Details

I. General information

NPI: 1649293002
Provider Name (Legal Business Name): KEVIN S. BEASLEY LCSW
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/26/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

PSC 37 BOX 2674
APO AE UNITED KINGDOM
09459
GB

IV. Provider business mailing address

17 BROOM RD
LAKENHEATH UNITED KINGDOM
IP279ES
GB

V. Phone/Fax

Practice location:
  • Phone: 01144
  • Fax: 528070
Mailing address:
  • Phone: 011441638
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLCSW3305
License Number StateHI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: