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NPI Code Detail

MEDICARE: ELEANOR M BEASON MSW LCSW

MEDICARE: ELEANOR M BEASON MSW LCSW
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
11041C0700XClinical Social Worker1418CAL
21041C0700XClinical Social WorkerCSW001620GA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1114240272
Entity Type Code : Individual
Provider Name (Legal Business Name) : ELEANOR M BEASON MSW LCSW
Provider Business Mailing Address
First Line : 1600 FORT BENNING RD
Second Line :
City : COLUMBUS
State : GA
Zip : 31903-2834
Country : US
Telephone Number : 706-322-9599
Fax Number : 706-221-8593
Provider Business Practice Location Address
First Line : 1600 FORT BENNING RD
Second Line :
City : COLUMBUS
State : GA
Zip : 31903-2834
Country : US
Telephone Number : 706-322-9599
Fax Number : 706-221-8593
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/03/2010
Last Update Date : 02/08/2017

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