Healthcare Provider Details

I. General information

NPI: 1851688170
Provider Name (Legal Business Name): ELISABETH ANNE BEARDSLEY MSW, LICSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MRS. ELISABETH ANNE BEARDSLEY

II. Dates (important events)

Enumeration Date: 07/07/2011
Last Update Date: 07/22/2026
Certification Date: 07/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

55 CODY DRIVE
POCA WV
25159-9035
US

IV. Provider business mailing address

55 CODY DRIVE
POCA WV
25159-9035
US

V. Phone/Fax

Practice location:
  • Phone: 304-881-1678
  • Fax: 800-796-4730
Mailing address:
  • Phone: 304-881-1678
  • Fax: 800-796-4730

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberDP00942941
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: