Healthcare Provider Details

I. General information

NPI: 1528154663
Provider Name (Legal Business Name): CARL J BEFFA LCSW
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/05/2006
Last Update Date: 02/18/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1318 JAMESTOWN RD SUITE 101
WILLIAMSBURG VA
23185-3382
US

IV. Provider business mailing address

1318 JAMESTOWN RD SUITE 101
WILLIAMSBURG VA
23185-3382
US

V. Phone/Fax

Practice location:
  • Phone: 757-645-4715
  • Fax: 757-645-4720
Mailing address:
  • Phone: 757-229-7927
  • Fax: 757-253-8891

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number0904000132
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: