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General NPI Number Information
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NPI Number | 1881570828
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Entity Type | Individual
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Provider Name | KYLE THOMAS BEVERIDGE LSW
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Gender | Male
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Dates
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Enumeration Date | 08/14/2025
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Last Update Date | 08/14/2025
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Provider Practice Location Address
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Address Line | 396 S CENTRE ST STE 3
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City | POTTSVILLE
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State | PA
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Zip | 17901-3597
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Country | US
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Telephone | 570-640-3744
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Fax | 570-516-9344
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Provider Business Mailing Address
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Address Line | 396 S CENTRE ST STE 3
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City | POTTSVILLE
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State | PA
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Zip | 17901-3597
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Country | US
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Telephone | 570-640-3744
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Fax | 570-516-9344
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 104100000X
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Taxonomy Name | Social Worker
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License Number | SW143235
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License Number State | PA
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