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General NPI Number Information
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NPI Number | 1326472820
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Entity Type | Organization
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Legal Business Name | CHUCK BEARDSLEY, LCSW LLC
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Dates
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Enumeration Date | 09/03/2013
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Last Update Date | 09/03/2013
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Provider Practice Location Address
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Address Line | 131 EUCLID AVE
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City | WESTFIELD
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State | NJ
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Zip | 07090
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Country | US
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Telephone | 908-264-5336
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Fax |
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Provider Business Mailing Address
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Address Line | 1054 LENAPE WAY
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City | SCOTCH PLAINS
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State | NJ
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Zip | 07076-2814
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Country | US
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Telephone | 908-264-5336
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Fax |
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Authorized Official
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Title or Position | OWNER/OPERATOR
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Name | MR. CHARLES B BEARDSLEY
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Credential | LCSW
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Telephone | 908-264-5336
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 44SC05510200
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License Number State | NJ
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